Endosteal implants / dentistry universities

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ENDOSTEALENDOSTEAL
IMPLANTSIMPLANTS
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

IntroductionIntroduction
 The goal of modern dentistry is to restoreThe goal of modern dentistry is to restore
the patient to normal contour, function,the patient to normal contour, function,
comfort, esthetics, speech and health.comfort, esthetics, speech and health.

 Factors effecting increased need and use ofFactors effecting increased need and use of
implant related treatments:implant related treatments:
1)1) Increased in aged populationIncreased in aged population
2)2) Tooth loss related to ageTooth loss related to age
3)3) Anatomic consequences of edentulismAnatomic consequences of edentulism
4)4) Poor performance of removable prosthesisPoor performance of removable prosthesis
5)5) Psychological aspect of tooth lossPsychological aspect of tooth loss
6)6) Predictable long term results of implantPredictable long term results of implant
supported prosthesissupported prosthesis
7)7) Advantages of implant supported prosthesisAdvantages of implant supported prosthesis

 Advantages of implant supported prosthesis:Advantages of implant supported prosthesis:
1)1) Maintenance of boneMaintenance of bone
2)2) Maintenance of occlusal vertical dimensionMaintenance of occlusal vertical dimension
3)3) Tooth positioned for estheticsTooth positioned for esthetics
4)4) Proper occlusionProper occlusion
5)5) Improved psychological healthImproved psychological health
6)6) Regained proprioceptionRegained proprioception
7)7) Increased stabilityIncreased stability

8)8) Increased phoneticsIncreased phonetics
9)9) Increased retentionIncreased retention
10)10) Reduced removable prosthesis sizeReduced removable prosthesis size
11)11) Improved success rate of prosthesisImproved success rate of prosthesis
12)12) Increased survival time of restorationIncreased survival time of restoration
13)13) Improved function of prosthesisImproved function of prosthesis
14)14) Maintenance of muscle of mastication &Maintenance of muscle of mastication &
facial expressionfacial expression

DefinitionDefinition
 According to GPT 8According to GPT 8
Dental implant is a biologic or alloplasticDental implant is a biologic or alloplastic
material surgically inserted into soft ormaterial surgically inserted into soft or
hard tissue of mouth for function andhard tissue of mouth for function and
esthetic purposes.esthetic purposes.

ClassificationClassification
Implants
Totally buried Semi buried
Sub periosteal Endosseous

Acc. To Weiss and WeissAcc. To Weiss and Weiss
IMPLANTS
ENDOSTEAL
SUBPERIOSTEAL
INTRAMUCOSAL INSERTS

Endosteal ImplantsEndosteal Implants
 An alloplastic material surgically insertedAn alloplastic material surgically inserted
into a residual ridge primarily asinto a residual ridge primarily as
prosthodontic foundationprosthodontic foundation
 Comprise broad category of implants theyComprise broad category of implants they
are the most commonly applicableare the most commonly applicable
abutment providing modality.abutment providing modality.

 In mainstream casesIn mainstream cases
endosteal implantsendosteal implants
are placed within fullyare placed within fully
or partially edentulousor partially edentulous
alveolar ridges withalveolar ridges with
sufficient residualsufficient residual
ridge volumeridge volume

 Advantages of endosteal implants:Advantages of endosteal implants:
1)1) A high degree of predictability inA high degree of predictability in
attainment of osseo-integrationattainment of osseo-integration
2)2) Versatile surgical and prosthodonticVersatile surgical and prosthodontic
protocolsprotocols
3)3) Design features that facilitate ease ofDesign features that facilitate ease of
treatment & estheticstreatment & esthetics
4)4) A low complication rate & ease ofA low complication rate & ease of
maintenancemaintenance

 Success criteria (Albertsson et al:Success criteria (Albertsson et al:
1986)1986)
1)1) An individual, unattached implant isAn individual, unattached implant is
immobile when tested clinicallyimmobile when tested clinically
2)2) A radiograph does not demonstrate anyA radiograph does not demonstrate any
evidence of peri implant radiolucency.evidence of peri implant radiolucency.
3)3) Vertical bone loss is less than 0.2 mmVertical bone loss is less than 0.2 mm
annually following implant’s first year ofannually following implant’s first year of
serviceservice

4)4) Individual implant performance isIndividual implant performance is
characterized by an absence of persistentcharacterized by an absence of persistent
and/or irreversible signs & symptoms such asand/or irreversible signs & symptoms such as
pain, infection, neuropathies, parasthesia orpain, infection, neuropathies, parasthesia or
violation of mandibular canalviolation of mandibular canal
5)5) In the context of the above, a success rate ofIn the context of the above, a success rate of
85% at the end of 5 year observation period &85% at the end of 5 year observation period &
80% at the end of 10 year period are minimum80% at the end of 10 year period are minimum
criteria for successcriteria for success

 According to Misch:According to Misch:
1)1) LongevityLongevity
2)2) PainPain
3)3) Rigid fixationRigid fixation
4)4) PercussionPercussion
5)5) Bone lossBone loss
6)6) Radiographic evaluationRadiographic evaluation

7)7) Peri-implant diseasePeri-implant disease
8)8) Probing depthProbing depth
9)9) Bleeding indexBleeding index

 Implant failureImplant failure::
1)1) Horizontal mobility beyond 0.5 mm orHorizontal mobility beyond 0.5 mm or
any clinically observed verticalany clinically observed vertical
movement under less than 500gm forcemovement under less than 500gm force
2)2) Rapid progressive bone loss regardlessRapid progressive bone loss regardless
of stress reduction & peri-implant therapyof stress reduction & peri-implant therapy
3)3) Pain during percussion or functionPain during percussion or function
4)4) Continued uncontrolled exudates inspiteContinued uncontrolled exudates inspite
of surgical attempts at correctionof surgical attempts at correction

5)5) Generalized radiolucency around anGeneralized radiolucency around an
implantimplant
6)6) More than one half of the surroundingMore than one half of the surrounding
bone is lost around an implantbone is lost around an implant
7)7) Implants inserted in poor position makingImplants inserted in poor position making
them useless for prosthetic supportthem useless for prosthetic support

ENDOSTEAL
IMPLANTS
ROOT FORM
PLATE/BLADE
FORM
ENDODONTIC
STABILIZERS

ENDOSTEAL IMPLANTS
BLADE FORM CYLINDRICAL SCREW SHAPED
PINS DISC LIKE

Osseo-integrationOsseo-integration
 ““direct bone anchorage to an implant bodydirect bone anchorage to an implant body
which can provide a foundation to supportwhich can provide a foundation to support
a prosthesis”a prosthesis”
 ““at least some direct contact of living boneat least some direct contact of living bone
with surface of an implant at lightwith surface of an implant at light
microscope level of magnification”microscope level of magnification”

 Factors effecting osseo-integration:Factors effecting osseo-integration:
1)1) BiocompatibilityBiocompatibility
2)2) Implant design –lengthImplant design –length
-diameter-diameter
-shape-shape
-surface characteristics-surface characteristics

3)3) Submerged and non submergedSubmerged and non submerged
protocolsprotocols
4)4) Bone factorsBone factors
5)5) Loading conditionsLoading conditions
6)6) Prosthetic loading considerationProsthetic loading consideration

Root form implantsRoot form implants
 It is major subcategory of endostealIt is major subcategory of endosteal
implantsimplants
 They are the most often used design formThey are the most often used design form
 They are designed to resemble the shapeThey are designed to resemble the shape
of natural tooth rootof natural tooth root
 As a rule root form must achieveAs a rule root form must achieve
osteointegration to succeedosteointegration to succeed

 Most are 2 stage implantsMost are 2 stage implants
 Can be placed any where in mandible orCan be placed any where in mandible or
maxilla where there is sufficient availablemaxilla where there is sufficient available
bonebone
 Can be threaded, smooth, stepped,Can be threaded, smooth, stepped,
parallel sided or tapered, with or withoutparallel sided or tapered, with or without
coating, with or without grooves or ventcoating, with or without grooves or vent
and can be joined to a wide varity ofand can be joined to a wide varity of
components for prosthesis retentioncomponents for prosthesis retention

STEPPED CYLINDER
MICRO THREADED TAPERED

PARALLEL SIDED WITH VENT

Components of root formComponents of root form
implantimplant

Fixture / BodyFixture / Body - Surgically placed into- Surgically placed into
the bonethe bone
Cover screwCover screw –– placed on top of theplaced on top of the
fixture to prevent invasion into thefixture to prevent invasion into the
threaded internal area of the fixturethreaded internal area of the fixture

Second stage permucosal extensionSecond stage permucosal extension
 Extends the implant above the softExtends the implant above the soft
tissuestissues
 Results in development of a permucosalResults in development of a permucosal
sealseal

AbutmentAbutment
 Portion of implantPortion of implant
that serves to supportthat serves to support
and/ or retain aand/ or retain a
prosthesis or implantprosthesis or implant
superstructuresuperstructure
20 degree 45degreewww.indiandentalacademy.comwww.indiandentalacademy.com

Transfer copingTransfer coping
 Implant bodyImplant body
copingcoping
 Abutment transferAbutment transfer
copingcoping
 Direct transferDirect transfer
copingcoping
 Indirect transferIndirect transfer
copingcoping

Direct impression coping

Indirect impression coping

Implant Analog

CopingCoping
PrefabricatedPrefabricated
CastableCastable

Healing Caps

AbutmentsAbutments
 Classified as:Classified as:
Prefabricated – standardPrefabricated – standard
- stock- stock
- angulated- angulated
Custom madeCustom made

Abutment DesignAbutment Design
 For cement retention:For cement retention:
straight abutmentstraight abutment
angled abutmentsangled abutments
 For screw retention:For screw retention:

Abutment for cement retentionAbutment for cement retention
 Advantages :Advantages :
1)1) PassivePassive
2)2) Occlusal surface remains intactOcclusal surface remains intact
3)3) Loosens lessLoosens less
4)4) Improved estheticsImproved esthetics
5)5) Fewer occlusal porcelain fracturesFewer occlusal porcelain fractures
6)6) Can be easily correctedCan be easily corrected
7)7) Easy manipulation in posterior regionEasy manipulation in posterior region
8)8) Less expensiveLess expensive
 Disadvantages:Disadvantages:

Abutments for screw retentionAbutments for screw retention
 Advantages:Advantages:
1)1) Greater prosthetic flexibilityGreater prosthetic flexibility
2)2) Permits use of short or low profile abutmentsPermits use of short or low profile abutments
3)3) Easy retreivabilityEasy retreivability
 Disadvantages:Disadvantages:

Attachment of abutments toAttachment of abutments to
implantsimplants
 For flat surfaced implantsFor flat surfaced implants
 For implants with anti-rotational featuresFor implants with anti-rotational features
External hexExternal hex
Internal hexInternal hex
Spline attachmentSpline attachment
Morse taper (cold weld)Morse taper (cold weld)

EXTERNAL HEX INTERNAL HEX

Abutment TypesAbutment Types
 Flat topped abutmentsFlat topped abutments
 Tapered shouldered abutmentsTapered shouldered abutments
 Direct gold copingsDirect gold copings
 Overdenture abutmentsOverdenture abutments

OVERDENTURE ABUTMENT
STRAIGHT SCREW RETAINEDwww.indiandentalacademy.comwww.indiandentalacademy.com

Implant recommendation relatedImplant recommendation related
to tooth anatomyto tooth anatomy
 Cemento enamel junction minus 2mm is aCemento enamel junction minus 2mm is a
good location to assess the average sizegood location to assess the average size
of a tooth root and determine the optimalof a tooth root and determine the optimal
implant size for replacing the toothimplant size for replacing the tooth

Principles of implant positioningPrinciples of implant positioning
 Vertical positioning – depthVertical positioning – depth
 Buccolingual positioning – widthBuccolingual positioning – width
 Mesiodistal positioning – lengthMesiodistal positioning – length
 Trajectory or angleTrajectory or angle

plate/ blade formplate/ blade form
 Supplied as one-stage and two-stageSupplied as one-stage and two-stage
 Can be tapered or parallel sidedCan be tapered or parallel sided
 Can be used in combination with naturalCan be used in combination with natural
tooth as co-abutmenttooth as co-abutment
 Required bone:Required bone:
>8mm of bone height>8mm of bone height
>3mm of width>3mm of width
>10mm bone length>10mm bone length

PLATE./ BLADE FORM IMPLANTS

 As with root form implants plate/bladeAs with root form implants plate/blade
form implants can be placed anywhere inform implants can be placed anywhere in
the mandible or maxilla wherever there isthe mandible or maxilla wherever there is
sufficient bone available. Howeversufficient bone available. However
because of the narrower buccolingualbecause of the narrower buccolingual
width of blade/plate form, they are morewidth of blade/plate form, they are more
applicable in wider range of available boneapplicable in wider range of available bone

 AdvantagesAdvantages ::
1)1) Succeeds in both osteointegration & osteo-Succeeds in both osteointegration & osteo-
preservation modepreservation mode
2)2) Low treatment costLow treatment cost
3)3) Low treatment timeLow treatment time
4)4) Low traumaLow trauma
5)5) Requires conventional prosthodonticRequires conventional prosthodontic
proceduresprocedures
6)6) Easy to place and simple armamtariumEasy to place and simple armamtarium
7)7) Increased implant interfaceIncreased implant interface

 Parts of blade/plate form implant:Parts of blade/plate form implant:
 AbutmentAbutment
 Safety stopSafety stop
 NeckNeck
 ShoulderShoulder
 VentsVents
 Shoulder set pointsShoulder set points

 Prosthodontic related advantages of rootProsthodontic related advantages of root
form implants compared with plate form:form implants compared with plate form:
1)1) Provide independent supportProvide independent support
2)2) Greater surface area for stress distributionGreater surface area for stress distribution
3)3) Permits better estheticsPermits better esthetics
4)4) Wide range of abutment optionsWide range of abutment options
5)5) Greater retention and resistanceGreater retention and resistance

5)5) Greater flexibilityGreater flexibility
6)6) Requires less skillRequires less skill
7)7) May be inserted at the level or below theMay be inserted at the level or below the
crest of the ridgecrest of the ridge

Endodontic stabilizerEndodontic stabilizer
 They are used toThey are used to
extend the functionalextend the functional
length of an existinglength of an existing
tooth roottooth root
 Improve prognosisImprove prognosis
and crown root ratioand crown root ratio

 Parallel sided orParallel sided or
taperedtapered
 Smooth or threadedSmooth or threaded
 ““sluice ways”sluice ways”
 Nomenclature:Nomenclature:
Major diameterMajor diameter
Minor diameterMinor diameter
PitchPitch

 Functions in osteopreservation modeFunctions in osteopreservation mode
 Need for atleast 5mm of available boneNeed for atleast 5mm of available bone
beyond apex of the toothbeyond apex of the tooth

Disk like implantsDisk like implants

ConclusionConclusion

bibliographybibliography
1)1) Contemporary implant dentistry – Misch 2 ednContemporary implant dentistry – Misch 2 edn
2)2) Principles & practice of implant dentistry –Principles & practice of implant dentistry –
Weiss & WeissWeiss & Weiss
3)3) Atlas of oral implants - CraninAtlas of oral implants - Cranin
4)4) Dental implant- the art & science – BabushDental implant- the art & science – Babush
5)5) Implants in clinical dentistry – Palmer, Smith,Implants in clinical dentistry – Palmer, Smith,
HoweHowe
6)6) Oral implantology - KakarOral implantology - Kakar

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