This document discusses dental implants, including their uses, types, placement locations, and procedures. Key points include: - Dental implants provide support for fixed or removable prostheses by being implanted in the oral tissues or bone. - Implant placement depends on the patient's condition and dental needs, as well as the quality and location of available bone. - Common types include endosteal implants placed within the bone, and various metallic and non-metallic implant materials. - Placement procedures involve initial surgery to insert the implant fixture, a healing period, attachment of an abutment, and final prosthetic restoration. Success rates above 90% are achievable when properly placed.

2.  A prosthetic device or alloplastic material
implanted into the oral tissue beneath the
mucosal or/and periosteal layer and/ or in the
bone to provide retention and support for the
fixed and removable prosthesis. - GPT

3.  Edentulous patient
 Partially edentulous patient with history of difficulty in
wearingR.P.D.
 Patient requiring long span F.P.D.treatment
 Patient who refuses wearing a removable prosthesis
 Patient with severe changes in C.D.bearing tissues
 Poor oral muscular coordination
 Parafunctional habits that compromise prosthesis stability
 Unrealistic patient expectation for complete denture
 Hyperactive gag reflex
 Patient psycologically against removable prosthesis
 Unfavourable number and location of abutments
 Single tooth loss, avoid preparation of sound teeth

4. Absolute Contraindications
 Recent myocardial infarction
 Valvular prosthesis
 Severe renal disorder
 Uncontrolled diabetes
 Uncontrolled hypertension
 Generalized osteoporosis
 Chronic severe alcoholism
 Radiotherapy in progress
 Heavy smoking

5. RELATIVE CONTRA INDICATIONS
 Cardiovascular problems
 Congestive heart failure
 Coronary artery disease
 Prosthetic heart valves
 Rheumatic heart disease
 Endocrine disorders (e.g., calcium, iron, avitaminosis, low
estrogen in females)
 Hyperactive involuntary muscle movements (e.g., Parkinson’s,
Huntington’s)
 Bone disorders (e.g., osteomyelitis, osteopetrosis, osteoporosis)
 Benign/malignant bone neoplasms or cysts and fibro-osseous
disease
 pregnancy

6.  Preservation of bone
 Improved function
 Aesthetics
 Stability and retention
 comfort

7.  Expensive
 Cannot be used in medically compromised pt.
 Who cannot undergo surgery.
 Many patients do not accept longer duration of
treatment and tedious fabrication procedures.
 Requires lot of patient cooperation
 Cannot be universally placed due to presence
of anatomical limitation.

8. 1) Depending on the placement within the
tissues
Epiosteal / Subperiosteal implants
Endosteal implants
Transosteal implants

10. i) METALLIC IMPLANTS
• titanium
• cobalt chromium molybdenum alloy- Titanium
aluminum vandium
• Cobalt chromium molybdenum
• Stainless steel
• Zirconium
• Tantalum
• Gold
• Platinum
ii. NON – METALLIC IMPLANTS - ceramics
- carbon

11. 3)Depending On Their Reaction With Bone:
a.Bio-active
• Hydroxyapatite
• Tri Calcium Phosphate
• Calcium Phosphate
b. Bio inert -metals

12. Commercially used -pure titanium
– Titanium-aluminum-vanadium alloy (Ti-6Al-4V) -
stronger & used with smaller diameter implants
Titanium
•Lightweight
•biocompatible
•corrosion resistant (dynamic inert oxide layer) •strong &
low-priced
•It is 6 times stronger than compact bone
•Its modulus of elasticity is 5 times greater than that of
compact bone (thus equal mechanical stress transfer)

13. Misch 1989 reported five prosthetic options of
implants.
 FP1- fixed prosthesis replaces only crown; looks
like a natural teeth.
 FP2- fixed prosthesis; replaces crown and portion
of root.
 FP3- fixed prosthesis replaces missing crowns and
gingival colour and portion of edentulous sites.
 RP4- removal prosthesis ; overdenture supported
completely by implant.
 RP5-removal prosthesis ; overdenture supported
by soft tissue and implant.

14. 1. Implant body or fixture
2. Healing screw
3. Healing caps
4. Abutments –resembles a prepared tooth and is
designed to be screw into the implant body.
5. Impression posts-small stem used to transfer the
intraoral location. They are placed over implant
body during impression making.

15.  Superstructure metal framework that attaches
to the implant abutment and provides either
retention for removable prosthesis or
framework for fixed prosthesis.
 Commonly used superstructures include
overdentures , fixed bridges ,fixed detachable
bridges and single crown.

16.  This includes medical , dental and diagnostic
evaluation.
Medical history
– vascular disease
– immunodeficiency
– diabetes mellitus
– tobacco use
– bisphosphonate use

17. History of Implant Site
• Factors regarding loss of tooth being replaced.
• Factors that may affect hard and soft tissues:
– Traumatic injuries
– Failed endodontic procedures
– Periodontal disease
• Clinical exam may identify ridge deficiencies

18. Dental evaluation

19. Dense cortical (D1) bone
 Highest bone implant contact (BIC) > 80%
 Anterior region of mandible very dense
compact bone
Dense to thick porous cortical and coarse
trabecular bone (D2)
 BIC = 70% 5.
 Dense to porous compact bone on the outside
and coarse trabecular bone on the inside .
 Anterior and posterior mandible

20. Thin porus cortical and fine trabecular bone (d3) BIC =
50 %
 Thinner porous compact bone and fine trabecular
bone
 Anterior or posterior maxilla and posterior
mandible
Fine trabecular bone (d4)
 BIC = < 25 % 5
 No cortical crestal bone
 posterior maxilla in long term edentulous patients

21.  Diagnostic evaluation
 Iopa
 Occlussal radiographs
 Lateral cephalometric radiographs
 OPG
 CBCT

22. STEP 1: INITIAL SURGERY STEP
2: OSSEOINTEGRATION PERIOD STEP
3: ABUTMENT CONNECTION STEP
4: FINAL PROSTHETIC RESTORATION

23. Surgical placements of implants

24. • Success Rates >90%
• Histologic definition –“direct connection between
living bone and loadbearing endosseous implants at
the light microscopic level.”
factors affecting:
 Biocompatibility of implant material
 Implant design
 Surface conditions
 Status of host bed
 Surgical technikque
 Implant loading

25. • Fibroosseous integration – “tissue to implant
contact with dense collagenous tissue between the
implant and bone”
• Seen in earlier implant systems.
• Initially good success rates but extremely poor
long term success.
• Considered a “failure” by todays standards

26. Maxillary anterior region
 Low quality and quantity As bone height
decreases the remaining bone narrows to close
approximation with nasal cavity, maxillary
sinus, incisive canal.
 It is limited to canine eminence areas.
 CANINE EMINENCE AREA MUCH
SUITABLE FOR IMPLANT PLACEMENT IN
MAXILLARY ARCH

27. MAXILLARY POSTERIOR REGION
 Due to resorption pattern, proximity of sinuses
and quality of bone implants are rarely placed
here. Severe bone resorption and low palatal
vault creates a difficult situation for implant
procedure.

28. MANDIBULAR ANTERIOR REGION
 This region between mental foramina has
adequate bone for 4-6 implants. Minimum of 7
mm from inferior border of mandible to the
crestal ridge is needed .
 In resorbed ridge mental foramina located on
top of the ridge;care is necessary to prevent
damage to it and possible paresthesia.

29. MANDIBULAR POSTERIOR REGION
 Implant placement is difficult in this region
because of presence of inferior alveolar nerve.
 There should be minimum 1mm clearance
between the implant apex and the canal.
 Pattern of bone resorption is almost same on
buccal and lingual side.
 Pattern of resorption in crestal region creates
variety of shapes from sharp edge to flat and
wide. Shorter length implants are necessary.

30.  MAXILLARY SINUS AND INFERIOR
ALVEOLAR CANAL ARE THE PRINCIPAL
ANATOMICAL SITES LIMITING THE
IMPLANT PLACEMENT

31. Complications
 Membrane perforation.
 Presence of bony septae which divide sinus
into separate compartments.
 Postoperative infection.
 Wound dehiscence.
 Barrier Membrane exposure.
 Transient sinusitis.

32.  Surgical Complications:
Inoperative Complications
1.Oversize Osteotomy.
2.Perforation of cortical plates.
3.Inadequate soft tissue flaps for Implant coverage.
4.Broken burs.
5.Improper Instrumentation
6.Hemorrhage.
7.Poor angulations & Position of Implant.

33.  PROSTHETIC COMPLICATIONS: Component
& framework breakage
1.Fractured Frameworks & Mesostructure bars
2.Partial loosening of cemented bars and
prostheses
3.Inaccurate fit of castings
4.Inadequate Torque application 5.
In accurate frame work abutment interface 6.
Occlusal factors
7.Implant Fracture

34. Ailing Implant
 The ailing implant is the least seriously affected
Implants.
 Nothing more than a radiographic evidence of
diminishing but static bone loss may direct the
implantologist to be suspicious

35. Failing Implant
 The failing implants are firm. Osseointegration
develops apically and is responsible for the
implants stability. Routine radiography reveals
progressive bone loss around the cervical areas
of the implant.
 Failing implants - Actinobacillus
actinomycetemcomitans
-Porphyromonas gingivalis

36. Failed Implant
The simplest definition of a failed implant is
mobility.
This can be diagnosed by:
… Tapping and receiving a dull sound.
… Manipulating by two mirror handles and
detecting movement.
… By the use of the Periotest and eliciting a
response of +9 or higher