History and development of Dental implants / dental courses

HISTORY, TERMINOLOGY
AND DEVELOPMENT OF
IMPLANTOLOGY
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

Introduction
Oral or Dental Implants have opened the
door to the 21st century in dentistry and oral
rehabilitation. They have increased the
treatment possibilities for patients and improved
the functional results of their treatment. Patients
who had to compromise their esthetic
appearance, chewing functionality and nutritional
intake due to complete or partial tooth loss can
now be restored back to various degrees of
normal esthetics and function.

Since the commercial distribution of Dental
Implants, the field of Oral Implantology has
undergone a rapid and progressive development.
Many professionals have branched off and
specialized in this particular field. Their continuing
research efforts reward this field with new
concepts and developments almost on a daily
basis.

Research efforts from many different
disciplines such as material science,
physics, medicine, biochemistry and
others form the foundation for continued
improvements in the field of Oral
Implantology as well as the hardware
being used. What several years ago was
considered to be an alternative or
experimental treatment in dentistry is often
today considered as the Standard
protocol now.

HISTORY AND
DEVELOPMENT OF
INTRA-
ORAL IMPLANTS

Early Historical Developments:
In 500 BC, The Etruscans, living in what is
now modern Italy, replaced missing teeth
with artificial teeth carved from the bones
of oxen.

Man has been searching for ways to replace missing
teeth for thousands of years. The first evidence of the
use of implants dates back to 600AD in the Mayan
population, which was found in 1931 by Dr. and Mrs.
Wilson Popenoe, an archeological team, who were
excavating in Honduras.

Ancient Egyptians used tooth shaped shells
and ivory to replace teeth.
In the 1700s John Linter suggested the
possibility of transplanting teeth of one
human into another

Modern implant dentistry began in the early 19th
century. Much experimentation was being done
about what material would work best as the
replacement tooth. Attempts were first made at
implanting natural teeth from another person's
mouth, but these implants suffered much
infection and were rejected by the host.

In 1809, Maggiolo fabricated a gold
implant which was placed into fresh
extraction sockets to which he attached a
tooth after a certain healing period.

In 1886 Edmunds was the first in the US to implant a
platinum disc into the jawbone, to which a porcelain
crown was fixed.
In 1887, a physician named Harris use of teeth made
of porcelain with a platinum post, instead of a gold post.

In the early 1990s Lambotte fabricated
implants of aluminum, silver,brass,red
copper, magnesium,gold and soft steel
plated with gold and nickel.
Greenfield in 1909 made a lattice cage
design of iridoplatinum and made the first
root form design.

Modern Historical Developments:
Early pioneers in this field include Dr.
Strock AE, who, in 1931 suggested using
Vitallium r, a metal alloy, for dental
implants.
Surgical cobalt chromium molybdenum
alloy was introduced to oral implantology in
1938 by Strock.
In 1940, Boths first reported bone fusing to
titanium

In 1941, Dr. Gustav Dahl of Sweden
provided a retentive mechanism for jaws that
were completely edentulous. This was the
introduction of the subperiosteal implant.

In 1946, Strock designed a two-stage screw implant
that was inserted without permucosal post.
In 1947, Manlio Formiggini of Italy developed an
implant made of tantalum.
In 1947, Raphael Chercheve designed a double
delinked spiral implant made of chrome-cobalt alloy.

THE BREAKTHROUGH
In 1952, a startling discovery was made which
had great implications for Tooth Replacement
Therapy. Dr. Per-Ingvar Branemark , an
Orthopedic Surgeon, discovered that the hollow
titanium rod used in the study was not
retrievable when the experiment was complete.
Further studies showed that the animal's bone
had directly attached to the titanium surface.
This phenomenon was called osseointegration.

The first practical application of
osseointegration was the implantation of
new titanium roots in an edentulous
patient in 1965. More than thirty years
later, the non-removable teeth attached
to these roots were still functioning
perfectly.

In the mid 1950’s,LEE introduced the use of
an endosseous implant with a central post
and circumferential extensions.

In the 1960s, emphasis was placed on making the
biomaterials more inert and chemically stable within
biologic environments.
By 1964, commercially pure titanium was accepted as
the material of choice for dental implants, and since that
time, almost all dental implants are made of titanium.

In 1967, Dr.
Leonard Linkow of
New York
introduced the
blade form implant.
These blades
came in a variety
of sizes and forms
and were the most
widely used type of
implant until the
1980s.

In 1970, the ramus endosseous implant was
developed by ROBERTS AND ROBERTS.
In 1975 the first synthodont aluminium oxide
implant was placed in a human

In 1975 the first synthodont aluminium
oxide implant was placed in a human
Vitreous carbon implants were first placed
in early 1970 by Grenoble
In early 1980s Tatum introduced Omni R
implant made of titanium alloy root form
implant with horizontal fins.

Niznick in 1980 introduced Core-vent, an endosseous
screw implant manufactured with a hydroxyapatite
coating.
Calcitek corporation began manufacturing and
marketing its synthetic polycrystalline ceramic
hydroxyapatite coated cylindrical post titanium alloy
implant.

In 1985, Straumann Company designed plasma
sprayed cylinders and screws to be inserted in a one
stage operation.
In 1988, a National Institute of Health (nih)
consensus development conference on
osseointegration in dental implants catalyzed the
acceptance and defined the criteria for success.

In 1988, National Institutes of Health (NIH)
Consensus and American academy of
implant dentistry recognize the term
“root form” .
Branemark devoted 13 years conducting
animal studies to determine the
parameters under which osseointegration
would occur. Based on his study titanium
was the made the material of choice.

INTRAORAL IMPLANT
TERMINOLOGY

Implant:- “A graft or insert set firmly or
deeply into or onto the alveolar process
that may be prepared for its insertion”.
(GPT-7)
Abutment:- “A tooth or portion of an
implant which protrudes through the
mucosa into the oral cavity for the
retention or support of a crown or a fixed
or removable denture prosthesis”.( GPT-7)

Implant denture:- “A denture which
receives its ability and retention from the
substructure which is partially or wholly
implanted under the soft tissue of the
denture base seat”. (GPT-7)
Dental substructure:- “ The metal
framework which is beneath the soft
tissues and in contact with bone for the
purpose of supporting an implant denture
superstructure”. (GPT-7)

Dental superstructure:- “The metal
framework which is retained and stabilized
by the implant denture substructure”.
(GPT-7)
 Edentulous (fully and partially) :-
“Simply stated, fully edentulous refers to
an individual that has no teeth at all in
either the upper or lower jaw. Partially
edentulous refers to missing one or more
teeth”.

Implant hygiene :- “In as much as
good oral hygiene habits are important; in
implant dentistry they are even more
important. The design of the teeth that are
fixed to the implant is critical to allow the
patient easy access to cleaning”.

Implant prosthodontics :- “This is a
branch of implant dentistry that is
concerned directly with the restorative
phase following implant placement and
the overall treatment plan before and after
the placement of dental implants”.

Protocol :- “Implant protocol is the regimen
and discipline that is strictly followed by the
general dentist, the implant surgeon, the implant
dental technician and any other team member”.
One of the most critical aspects of implant
dentistry is proper pre-treatment planning within
a team approach.
prosthodontist :- In Implantology, his/her
responsibilities are to diagnose, evaluate and to
plan the treatment of the patient. The steps to
follow in having implants should be personally
suited to the patient by the prosthodontist.

Surgeon:- Implantology is not
considered a specialty branch of dentistry.
Surgical procedures can be performed by
an oral surgeon, a periodontist. The
surgeon's responsibility is to select the
appropriate shape and size of implant to
be placed precisely where the dentist has
requested. The qualified surgeon also
performs other implant related surgeries,
such as bone grafting, sinus lifts, etc.

Team approach :- In conventional
dentistry, a dentist works alone. His/her practice
revolves primarily around their skills and
experience. Implant dentistry is a multi-skilled
field. The prosthodontist works closely with the
oral surgeon or periodontist who will be
performing the surgical aspects. The implant
dental technician will also be involved with
making of the teeth. Also involved on the implant
team are the x-ray technicians, dental
assistants, surgical assistants, implant
manufacturers and, of course, the patient's
positive attitude.

Membrane: – In the field of dental
implant surgery it is referred to as a little
sheet made up of different materials
(GoreTex, Collagen etc.) and designed to
protect a grafted bone site from influx of
soft tissue cells. Soft tissue cells would
compromise bone healing, since they
proliferate at a faster rate than bone cells.
Oral Implantology: – “A specialized
field of dentistry, dealing with the
placement and restoration of dental
implants”. www.indiandentalacademy.com

 Titanium: – Although by some considered an exotic
metal it is actually one of the most abundant elements on
earth. However, it took scientific advances of modern
metallurgy to turn this black sand into useful metal.
Commercially pure titanium currently comes in four
different grades (1-4), grade 4 being the finest. Most
dental implants are either machined out of commercially
pure titanium or an alloy thereof. The most frequently
used alloy is Ti Al6V4. This alloy improves the fracture
resistance of titanium and does not compromise the
osseointegration into bone.

Osseointegration: - “The fusion of the
surface of a dental implant to the surrounding
bone, so that it is secured tightly in the bone and
ready to be used as an anchor for a tooth or
prosthesis”.(GTP-7)
Osseointegration:- “A condition that
exists when a titanium implant is inserted,
screwed or pressed into living bone. The result
is a biological bond of living bone to the titanium
implant. In essence, the two become one”.

Osseointegration:- defined by the
American Academy of Implant Dentistry as
"the firm, direct and lasting biological
attachment of a metallic implant to vital
bone with no intervening connective
tissue."

 A generic language for endosteal implants
has been developed by MISCH & MISCH.
 No single design is considered best for
restoring all conditions. Each design type
is useful in Tooth Replacement Therapy.
 As a general rule, greater the functional
surface area of the bone implant contact,
the better the support the system for
prosthesis.

Intra-oral Implants can be categorized
into three main groups:
 Endosseous Implants :-are implants that are
surgically inserted into the jawbone.
Root form.
Blade (plate) form.
Ramus frame.

Rootform Implant.
 Nowadays, the most common implant used in the
dental community.
 The reason they are called Rootform Implants
is because they closely resemble the shape of
the original root of the lost tooth and design
to use a vertical column of bone.

Subperiosteal Implants :-are implants,
which typically lie on top of the jawbone, but
underneath the gum tissues. The important
distinction is that they usually do not
penetrate into the jawbone.

Transosseous
Implants:- are surgically
inserted into the
jawbone. However,
these implants actually
penetrate the entire jaw
so that they actually
emerge opposite the
entry site, usually at the
bottom of the chin.

implant
Implant body (fixture) Implant prosthetic componentsImplant body Implant prosthetic component
Crest module A body An apex region
# First stage cover screw
# Second stage permucosal
Extension OR
healing abutment
# Abutment
# Hygiene screw
# Transfer coping
# Implant analog
# Coping
# Prosthesis screw

 Implant/Fixture is the
actual part that is
inserted into the bone.
 Prosthesis:- the crown
(tooth), and an
attachment (abutment)
with a screw..

Implant body / fixture
referred to surgically placed part which goes
either into or set on the top of the jaw bone.
crest module
The crest module of an implant is that portion designed
to retain the prosthetic component in a two piece system.
It also represents the transition from the implant body
design to the transosteal region of the implant at the
crest of the ridge.
This platform offers physical resistance to axial occlusal
load, on which the abutment is set.

Following prosthetic component of implant
placed in different phases of implant placement.
First stage cover screw:-
Placed at the time of insertion of implant
body or stage I surgery.
placed into the top of the implant to
prevent bone, soft tissue or debris during healing.

Second stage healing abutment:-
After a prescribed healing period , a second
stage procedure is performed to exposed
implant at transepithelial portion i.e. above the
soft tissue.
it is placed in place of cover screw to
allow the pericircular area of mucous membrane
heal properly and keratinized.

Abutment:-
is the portion of the implant that support and
retained a prosthesis or implant suprastucture and
is then connected to the implant body.

Hygiene screw
placed over the abutment to prevent debris and
calculus from invading the internally threaded
portion of the abutment during prosthesis
fabrication between prosthetic appointments.

Transfer coping
Use to transfer the design of implant to a master
cast for prosthesis fabrication.
Indirect transfer coping:- in which transfer coping
screwed into the abutment in place when set
impression Is removed from the mouth.
Direct transfer coping:- after impression is set,
transfer coping is transfer into the impression at
the time of removal.

Implant analog
Used in fabrication of the master cast to replicate
the retentive portion of the implant body or
abutment.
After the master impression is obtained the
corresponding analog is attached to the transfer
coping and the assembly is poured in stone to
fabricate the master cast.

Prosthetic coping:- is a thin covering,
serve as the connection between the
abutment and the prosthesis.
Prefabricated coping:- metal component
machined precisely to fit the abutment.
Castable coping:- is a plastic pattern cast
in the same metal as the prosthesis.
Prosthetic screw:- a screw retained
prosthesis is secured to the implant body
or abutment.

The Prosthesis
The Abutment
The Implant
The Crown
The Root-
The Ligaments-

As the use of implants was finally endorsed
by science, dental schools began to slowly
inculcate the teaching of Implantology in their
regular syllabus. Over the last 20 years we have
witnessed the emergence of an entirely new
scientific discipline which requires the integration
of surgical, prosthetic and biomechanical
concepts. Today, implants are recognized as the
treatment of choice for tooth replacement in
widely varying cases, including those where
previously the prognosis used to be hopeless.
CONCLUSION

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