Evolution classification and components of implants/ orthodontic therapist courses

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EVOLUTIONEVOLUTION
CLASSIFICATIONCLASSIFICATION
ANDAND
COMPONENTSCOMPONENTS
OF IMPLANTSOF IMPLANTS
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

INTRODUCTIONINTRODUCTION
 Implants are devices inserted into theImplants are devices inserted into the
body below the skin or oral mucosalbody below the skin or oral mucosal
membranemembrane
 They are used to improve the stabilityThey are used to improve the stability
of dental prosthesisof dental prosthesis

EVOLUTION OF IMPLANTSEVOLUTION OF IMPLANTS
 They have a history almost as old as thatThey have a history almost as old as that
of dentistryof dentistry

 Early Historical Developments:Early Historical Developments:
- bone-anchored device- bone-anchored device
- Ancient history of dental implants dates- Ancient history of dental implants dates
back to Egyptian times when sea shellsback to Egyptian times when sea shells
were literally hammered into the jaw towere literally hammered into the jaw to
replace missing teethreplace missing teeth

 In the 18th century lost teeth wereIn the 18th century lost teeth were
sometimes replaced with extracted teethsometimes replaced with extracted teeth
of other humanof other human donorsdonors..
 1809 -1809 - MaggioloMaggiolo

 1887 -1887 - HarrisHarris
 1886 –1886 – EdmundsEdmunds
 1937 -1937 - StrockStrock

 1937 – Gustav Dahl , subperiosteal1937 – Gustav Dahl , subperiosteal
implantsimplants
 1948 – Gershkoff and Goldberg1948 – Gershkoff and Goldberg
 1966 – Linkow , Endosseous blade vent1966 – Linkow , Endosseous blade vent
implantsimplants

 1952 -1952 - Per IngvarPer Ingvar BranemarkBranemark in thein the
Laboratory of Vital Microscopy at the UniversityLaboratory of Vital Microscopy at the University
of Goteberg, Sweden.of Goteberg, Sweden.
 OsseointegrationOsseointegration
 The Osseointegration concept evolved closelyThe Osseointegration concept evolved closely
coupled with the design of a cylindrical titaniumcoupled with the design of a cylindrical titanium
screw with a specific surface treatment toscrew with a specific surface treatment to
enhance its bioacceptance.enhance its bioacceptance.

 Around 1980, Branemark brought hisAround 1980, Branemark brought his
research to the U.S.research to the U.S.
 Reported results of prospective clinicalReported results of prospective clinical
research trials of totally edentulousresearch trials of totally edentulous
patients restored with dental implantspatients restored with dental implants
(since 1952)(since 1952)

 In 1982, the Toronto Conference onIn 1982, the Toronto Conference on
Osseointegration in Clinical Dentistry laidOsseointegration in Clinical Dentistry laid
down the first parameters on what is to bedown the first parameters on what is to be
considered successful implant treatmentconsidered successful implant treatment
within the stringent confines of thewithin the stringent confines of the
scientific communityscientific community

The Original Titanium ScrewThe Original Titanium Screw

 1981 – ITI non submerged implant system1981 – ITI non submerged implant system
 1983 – IMZ (Krisch, Babbush and Mentag)1983 – IMZ (Krisch, Babbush and Mentag)
 1985 – Bicon (Driskell, Stryker and Bicon)1985 – Bicon (Driskell, Stryker and Bicon)
 1989 – 3i (Lazzara)1989 – 3i (Lazzara)

 1986 – The year that root form implants1986 – The year that root form implants
superceded the blade form implants assuperceded the blade form implants as
“the most frequently placed type of“the most frequently placed type of
implant”implant”

 1984 – CT Scan1984 – CT Scan
 1987 – Sinus lift1987 – Sinus lift
 1988 – nerve Transposition1988 – nerve Transposition
 1989 – Pterygoid implants1989 – Pterygoid implants
 1991 – GTR1991 – GTR

 For most of this period they have beenFor most of this period they have been
dominated by the belief that success wasdominated by the belief that success was
predominantly design related althoughpredominantly design related although
more recently the importance of materialmore recently the importance of material
of construction was also recognisedof construction was also recognised

CLASSIFICATION OFCLASSIFICATION OF
IMPLANTSIMPLANTS

WILLIAM’S CLASSIFICATIONWILLIAM’S CLASSIFICATION
Implants
For prosthetic treatment
For endodontic stabilization
For periodontal sugery
For simulation congenitally
Absent tissue
For treatment of facial fractures
Directly Indirectly

Implants
Totally buried Semi buried
Sub periosteal Endosseous

ACC. TO WEISS AND WEISSACC. TO WEISS AND WEISS
IMPLANTS
ENDOSTEAL
SUBPERIOSTEAL
INTRAMUCOSAL INSERTS

Root Form Blade Formwww.indiandentalacademy.comwww.indiandentalacademy.com

Subperiosteal Implantwww.indiandentalacademy.comwww.indiandentalacademy.com

Intra mucosal insertwww.indiandentalacademy.comwww.indiandentalacademy.com

 Dynamic dental implant classificationDynamic dental implant classification
(AFNOR,1998)(AFNOR,1998)
• Axially insertedAxially inserted
• Laterally insertedLaterally inserted
 ““All Quality Bone” Structure implantAll Quality Bone” Structure implant

Axial insertion Lateral insertionwww.indiandentalacademy.comwww.indiandentalacademy.com

ENDOSTEAL IMPLANTSENDOSTEAL IMPLANTS
 Alloplastic material surgically inserted intoAlloplastic material surgically inserted into
a residual bony ridge primarily to serve asa residual bony ridge primarily to serve as
a prosthodontic foundationa prosthodontic foundation
 Root forms and blade formsRoot forms and blade forms mostmost
commonly used typescommonly used types

Mandibular ramus frame implant

ROOT FORMROOT FORM
 Resemble the shape of a natural toothResemble the shape of a natural tooth
rootroot
 Usually circular in cross sectionUsually circular in cross section
 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 a ventcoating, with or without grooves or a vent
 Must achieve osseointegration to succeedMust achieve osseointegration to succeed

Stepped cylinder Threadedwww.indiandentalacademy.comwww.indiandentalacademy.com

 1988 - National Institutes of Health consensus1988 - National Institutes of Health consensus
statement on dental implants and Americanstatement on dental implants and American
Academy of Implant Dentistry recognize theAcademy of Implant Dentistry recognize the
term root formterm root form
 Primary types based on design:Primary types based on design:
Cylinder or press fitCylinder or press fit
Screw formScrew form
CombinationCombination

 Screw root form:Screw root form:
V – threadV – thread
Buttress threadButtress thread
Power(square)Power(square)
threadthread
 Implant bodyImplant body
Crest moduleCrest module
BodyBody
Apex regionApex region

Blade / Plate FormBlade / Plate Form
 Tapered orTapered or
parallel sidedparallel sided
 Narrower bucco-Narrower bucco-
lingual widthlingual width

Ramus Frame ImplantRamus Frame Implant
 Safe and effectiveSafe and effective
 Total mandibular edentulism withTotal mandibular edentulism with
severe alveolar ridge resorptionsevere alveolar ridge resorption

SUBPERIOSTEAL IMPLANTSSUBPERIOSTEAL IMPLANTS
 1937 – Gustav Dahl1937 – Gustav Dahl
 1948 – Gerhkoff and Goldberg1948 – Gerhkoff and Goldberg
 1951 – Lew and Berman1951 – Lew and Berman
 1978 – Cranin1978 – Cranin
Early 1940’s – Co-Cr alloysEarly 1940’s – Co-Cr alloys
1980’s – Hydroxy apatite1980’s – Hydroxy apatite

Subperiosteal metal frameworkwww.indiandentalacademy.comwww.indiandentalacademy.com

 SubstructureSubstructure
 Permucosal postsPermucosal posts
 Super structureSuper structure
Primary struts
Secondary struts

Unilateral Subperiosteal implantwww.indiandentalacademy.comwww.indiandentalacademy.com

TRANSOSTEAL IMPLANTSTRANSOSTEAL IMPLANTS
 Most surgicallyMost surgically
invasiveinvasive
 MandibularMandibular
staple implantstaple implant

Tranosteal implant framework

Transosteal implantwww.indiandentalacademy.comwww.indiandentalacademy.com

Endodontic StabilizersEndodontic Stabilizers
 Extend length of toExtend length of to
existing tooth rootexisting tooth root
to improveto improve
prognosisprognosis
 Threaded andThreaded and
parallel sided withparallel sided with
sluice ways insluice ways in
threaded crestthreaded crest

Intra Mucosal InsertsIntra Mucosal Inserts
 Attached to tissue surface of prosthesisAttached to tissue surface of prosthesis
 Provide support but do not provideProvide support but do not provide
abutmentabutment
Intra mucosal insertwww.indiandentalacademy.comwww.indiandentalacademy.com

ABUTMENTSABUTMENTS
 Joined to fixture with abutment screwJoined to fixture with abutment screw
 Types:Types:
• PrefabricatedPrefabricated
• Custom madeCustom made

Single piece Two piece abutmentwww.indiandentalacademy.comwww.indiandentalacademy.com

 Acc to method by which prosthesis isAcc to method by which prosthesis is
retained to abutment:retained to abutment:
• Abutment for screwAbutment for screw
• Abutment for cementAbutment for cement
• Abutment for attachmentAbutment for attachment
Each of the three types of abutments mayEach of the three types of abutments may
be further classified into straight or angledbe further classified into straight or angled

 An Abutment for screw uses aAn Abutment for screw uses a
hygiene cover screw placed overhygiene cover screw placed over
the abutment between prostheticthe abutment between prosthetic
appointmentsappointments

TERMINOLOGYTERMINOLOGY
 The generic language for endostealThe generic language for endosteal
implants, both root forms and plate forms,implants, both root forms and plate forms,
has been developed by Misch and Mischhas been developed by Misch and Misch
 It is presented in an order similar to theIt is presented in an order similar to the
method of insertion and restoration.method of insertion and restoration.

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

Angulatedwww.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

COMMERCIALLY AVAILABLECOMMERCIALLY AVAILABLE
IMPLANT SYSTEMSIMPLANT SYSTEMS

BRANEMARK IMPLANTBRANEMARK IMPLANT
 Branemark fixtureBranemark fixture
 AbutmentsAbutments
 Checked radiographicallyChecked radiographically
 Healing capHealing cap
Straight
Angled for screw

 Impression copingImpression coping
 Fixture or implant replicaFixture or implant replica

ASTRA TECH IMPLANTASTRA TECH IMPLANT
 Parallel sided, self tappingParallel sided, self tapping
 Top part has micro threaded conical collarTop part has micro threaded conical collar
 TiO blastedTiO blasted
 Conical sealConical seal
 Internal hex designInternal hex design

STRAUMANN IMPLANTSTRAUMANN IMPLANT
 Solid screw designSolid screw design
 Plasma SprayedPlasma Sprayed
 SLA (sand blasted-large grit-acid etched)SLA (sand blasted-large grit-acid etched)
 Trans mucosal collarTrans mucosal collar

FRIALIT IMPLANTFRIALIT IMPLANT
 Tapered, stepped cylinderTapered, stepped cylinder
 Both plasma sprayed and acid etched withBoth plasma sprayed and acid etched with
grit blastedgrit blasted
 Abutment is parallel sidedAbutment is parallel sided
 Silicone washerSilicone washer

 Calcitek – 1981Calcitek – 1981
Integral Omniloc fixtureIntegral Omniloc fixture
 Dentsply- Gerald Niznick (1984-86)Dentsply- Gerald Niznick (1984-86)
 Steri - oss systemSteri - oss system

IMZ ImplantIMZ Implant
 Developed by Axel kirsch (1980-83)Developed by Axel kirsch (1980-83)
 Prosthetic components include IntraProsthetic components include Intra
Mobile ElementMobile Element
 Highly polished Ti – transmucosal implantHighly polished Ti – transmucosal implant
extension for optimal soft tissueextension for optimal soft tissue
adaptationadaptation

BIBLIOGRAPHYBIBLIOGRAPHY
 Contemporary Implant Dentistry- MischContemporary Implant Dentistry- Misch
 Atlas of Oral Implants- CraninAtlas of Oral Implants- Cranin
 Fundamentals Of Implant Dentistry- WeissFundamentals Of Implant Dentistry- Weiss
and Weissand Weiss
 Implants For Clinical Practitionar- DunitzImplants For Clinical Practitionar- Dunitz
 Oral implantology- KakarOral implantology- Kakar

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