Successfully reported this slideshow.

Dental implant introduction

107

Share

Marwan M. El Said
BDS. MSc.
History of dental implant
• 2500 B.C. the Egyptians used gold wire ligatures
to help stabilize damaged or loose teeth.
• T...
• The first root form two pieces implants used
by Greenfield made from iridoplatinum .
• Strock introduced cobalt chromium...

YouTube videos are no longer supported on SlideShare

View original on YouTube

Upcoming SlideShare
Blood 1
Blood 1
Loading in …3
×
1 of 120
1 of 120

Dental implant introduction

107

Share

Download to read offline

lecture 1
Dental implant introduction
1- implant history
2-micro and macro inplant desigen features
3- patient medical evaluation
4- introduction to treatment planning

lecture 1
Dental implant introduction
1- implant history
2-micro and macro inplant desigen features
3- patient medical evaluation
4- introduction to treatment planning

More Related Content

Related Books

Free with a 14 day trial from Scribd

See all

Dental implant introduction

  1. 1. Marwan M. El Said BDS. MSc.
  2. 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. 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. 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. 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. 6. Dental implant classification
  7. 7. According to material • Pure titanium (cpTi grade 4) • Titanium alloy (Ti 6 Al 4V) • Ceramic • Polymers
  8. 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. 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. 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. 11. Polymer implants • methyl methacrylate resin • Not biocompatible but biologically tolerable • inferior mechanical properties • lack of adhesion to living tissues • adverse immunologic reactions.
  12. 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. 13. Macroscopic Features • Body Design subperiosteal frame-like transmandibular implants endosseous • Bladelike • Pins • Root form implants cylindrical tapered screw shaped
  14. 14. subperiosteal frame
  15. 15. subperiosteal frame
  16. 16. subperiosteal frame
  17. 17. transmandibular implants
  18. 18. transmandibular implants
  19. 19. Endosseous implants • Bladelike
  20. 20. pins
  21. 21. Cortically fixed @ once
  22. 22. Basal implants
  23. 23. Cylindrical implant
  24. 24. tapered screw shaped implant
  25. 25. tapered screw shaped implant
  26. 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. 27. • Tapered screw implants can be : Two piece implant Single piece implant
  28. 28. Submerged Non-submerged
  29. 29. Solid Hollow Vented
  30. 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. 31. Forces distribution Tensile and shear forces Compressive forces unfavorable favorable
  32. 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. 33. • If implant length is the same, a smaller pitch means there are a greater amount of threads
  34. 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. 35. • The lead is the distance from the center of the thread to the center of the same thread after one turn.
  36. 36. • this could be the distance the implant would advance if it was advanced one turn
  37. 37. • implant could have a single ,double or triple thread design in which two or three threads run parallel to each other
  38. 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. 39. • Thread depth the distance from the tip of the thread to the body of the implant
  40. 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. 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. 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. 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. 44. • Thread shape describes the geometry of the implant thread • five types of thread geometry V-shape, square, buttress, reverse buttress and spiral
  45. 45. Implant platform
  46. 46. Implant platform
  47. 47. Implant platform switching
  48. 48. Implant abutment connection • External hex • Internal hex • Mores taper
  49. 49. Abutments
  50. 50. Microscopic Features • Implants can be Smooth Machined  roughed Coated
  51. 51. Patient evaluation and treatment planning
  52. 52. Oral surgery prosthodonticsperiodontics
  53. 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. 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. 55. The disease control is more important than the disease itself. (Dios y cols; 2013)
  56. 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. 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. 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. 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. 60. Absolute contraindications • Autoimmune diseases like AIDS • Risks: Osseointegration failure. Post-operative infection. • Solutions: Finding an alternative to conventional dental implants.
  61. 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. 62. Absolute contraindications • Cardiovascular disease • recent myocardial infarction, valvular disease, heart failure • Risks: Death • Solutions: Finding an alternative to conventional dental implants.
  63. 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. 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. 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. 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. 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. 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. 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. 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. 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. 72. Are orthodontic treatments a contraindication to implants?
  73. 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. 74. Dental History • Chief complaint • Pain/emergency • Past dental treatment • Past dental experiences • Previous dental prosthesis (How long?)
  75. 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. 76. • What are the causes of increased failure rates? • Why is the patient seeking dental treatment? • What are the patient priorities ?
  77. 77. Biological risk factors Vs Biomechanical risk factors
  78. 78. Implants success rate is about 97% VS implants are one of the treatment modalities for replacement of missing teeth

×