History and evolution of implants/ dental courses

HISTORY AND EVOLUTION OFHISTORY AND EVOLUTION OF
IMPLANTSIMPLANTS
INDIAN DENTAL ACADEMYINDIAN DENTAL ACADEMY
Leader in continuing Dental EducationLeader in continuing Dental Education
www.indiandentalacademy.comwww.indiandentalacademy.com

CONTENTSCONTENTS
 IntroductionIntroduction
 DefinitionsDefinitions
 History and Evolution of implants can be studied asHistory and Evolution of implants can be studied as
-The ancient era-The ancient era
- The Medieval period- The Medieval period
- The foundational period- The foundational period
- The Premodern era- The Premodern era
- The dawn of the modern era- The dawn of the modern era
- Contemporary oral implantology- Contemporary oral implantology
 Recent advancesRecent advances
 Summary and ConclusionSummary and Conclusion
 Referrences.Referrences.

 INTRODUCTION

 Def of Implant (GPT 8 )Def of Implant (GPT 8 )
 Any object or material such as an alloplastic substance orAny object or material such as an alloplastic substance or
other tissue, which is partially or completely inserted orother tissue, which is partially or completely inserted or
grafted into the body for therapeutic, diagnostic, prosthetic orgrafted into the body for therapeutic, diagnostic, prosthetic or
experimental purposes.experimental purposes.
 Def of ImplantologyDef of Implantology
 Term historically conceived as the study or science ofTerm historically conceived as the study or science of
planning and restoring dental implants.planning and restoring dental implants.

 Def of Dental ImplantDef of Dental Implant
 A prosthetic device made of alloplastic material implanted intoA prosthetic device made of alloplastic material implanted into
the oral tissues beneath the mucosal or/ & periosteal layerthe oral tissues beneath the mucosal or/ & periosteal layer
&/or within the bone to provide retention & support for a fixed&/or within the bone to provide retention & support for a fixed
or removable dental prosthesis ;a substance that is placed intoor removable dental prosthesis ;a substance that is placed into
or / & upon the jaw bone to support a fixed or removableor / & upon the jaw bone to support a fixed or removable
dental prosthesis.dental prosthesis.
 Def. Of OsseointegrationDef. Of Osseointegration
 The apparent direct attachment or connection of osseousThe apparent direct attachment or connection of osseous
tissue to an inert, alloplastic material without interveningtissue to an inert, alloplastic material without intervening
connective tissue.connective tissue.

 ANCIENT ERA - 1000 A.DANCIENT ERA - 1000 A.D

 There are evidences in the ancient manuscripts that theThere are evidences in the ancient manuscripts that the
dentistry has been performed since 3000 B.C .dentistry has been performed since 3000 B.C .
 Dental implants and transplants history can be traced toDental implants and transplants history can be traced to
Africa ( Egyptians ), to the Americans Mayans, Aztecs,Africa ( Egyptians ), to the Americans Mayans, Aztecs,
Incans ) and to the middle east. The history of toothIncans ) and to the middle east. The history of tooth
transplants can be traced to Greecks, Etruscans, Romanstransplants can be traced to Greecks, Etruscans, Romans
 HISTORY TRACED IN MIDDLE EASTHISTORY TRACED IN MIDDLE EAST
 In 1862 Gaillardot discovered aprosthodontic appliance near the ancientIn 1862 Gaillardot discovered aprosthodontic appliance near the ancient
city of Sidon. Appliance was dating 400 B.C period consisting of thecity of Sidon. Appliance was dating 400 B.C period consisting of the
four natural teeth holding carved ivory tooth replacing the two missingfour natural teeth holding carved ivory tooth replacing the two missing
incisors held together by the gold wire.incisors held together by the gold wire.
 HISTORY TRACED IN THE EGYPTIAN DYNASTIESHISTORY TRACED IN THE EGYPTIAN DYNASTIES
 Evidences have shown the implantation of animal teeth & artificial teethEvidences have shown the implantation of animal teeth & artificial teeth
carved of ivory .carved of ivory .
 Prior to mumificationPrior to mumification

 IN 1981 evidences of oldest dental implant was found in theIN 1981 evidences of oldest dental implant was found in the
Kalavak Necropolis, near Izmir , Turkey.Kalavak Necropolis, near Izmir , Turkey.
 The discoveries were dated back to 550 B.C . A canine tootThe discoveries were dated back to 550 B.C . A canine toot
like object made of two piece of calcite having hardnesslike object made of two piece of calcite having hardness
simillar to natural teth showing wear on the chewing surfacesimillar to natural teth showing wear on the chewing surface
& secured with gold wires wrapped around the neck of& secured with gold wires wrapped around the neck of
adjacent teethadjacent teeth

 Cranin suggested that earliest recorded dental implantCranin suggested that earliest recorded dental implant
specimen was inserted durind thespecimen was inserted durind the PRE _ COLUMBIAN Era.Era.
 In 1931 Wilson Popenoe discovered a skull in the UluaIn 1931 Wilson Popenoe discovered a skull in the Ulua
river valley of Honduras , dating to the periodriver valley of Honduras , dating to the period 600 A.D600 A.D . Skull. Skull
had an artificial tooth replacing lower left lateral incisor,had an artificial tooth replacing lower left lateral incisor,
carved from the dark stone . Radiographs showed the evidencecarved from the dark stone . Radiographs showed the evidence
of compact bone arround the implants.of compact bone arround the implants.
 The Mayans practiced the implantation of alloplastic materials in livingThe Mayans practiced the implantation of alloplastic materials in living
persons. Evidences of cosmetic and implant dentistry.persons. Evidences of cosmetic and implant dentistry.

 MEDIEVAL PERIOD (1000-1799)

 Allotransplantation (18 -19 C) mainly in England & ColonialAllotransplantation (18 -19 C) mainly in England & Colonial
America.America.

Mainly concerned with the transplantation of teethMainly concerned with the transplantation of teeth..
 Albucasis de Condue ( 936- 1013) an Arab surgeon describedAlbucasis de Condue ( 936- 1013) an Arab surgeon described
the transplantaton procedures . He attempted to use ox bone tothe transplantaton procedures . He attempted to use ox bone to
replace missing teeth.replace missing teeth.
 In Japan in the 15In Japan in the 15thth
& 16& 16thth
C. Wooden dowel & crownC. Wooden dowel & crown
prosthesis was designed . The pin inserte into the root canal ofprosthesis was designed . The pin inserte into the root canal of
non vial teeth. This wasan earlynon vial teeth. This wasan early ENDODONTIC IMPLANTENDODONTIC IMPLANT
– SUPPORTED PROSTHESIS.– SUPPORTED PROSTHESIS.

• Ambroise PareAmbroise Pare, a french physician , a surgeon to four kings of, a french physician , a surgeon to four kings of
France.France.
• He replaced the missing teeth with implants made up of boneHe replaced the missing teeth with implants made up of bone
& ivory .& ivory .
• His successful transplanting case report……His successful transplanting case report……
• Princess had missing anterior tooth , he transplanted atoothPrincess had missing anterior tooth , he transplanted atooth
taken from the made into princess extracted tooth sockettaken from the made into princess extracted tooth socket
successfully.successfully.

• The first written work on dentistry came fromThe first written work on dentistry came from Charles AllenCharles Allen
in 1687.in 1687.
• He described the replanting of tooth into the same patient thatHe described the replanting of tooth into the same patient that
lost it.lost it.
• Allen emphasized on trasplantation of tooth using animalAllen emphasized on trasplantation of tooth using animal
tooth, instead of other person’s extracted toothtooth, instead of other person’s extracted tooth
• In European sphere transplantation became the commonIn European sphere transplantation became the common
practice performed by barber surgeons of the Era.practice performed by barber surgeons of the Era.
• The tooth transplant could lad to transfer of diseases .The tooth transplant could lad to transfer of diseases .
• Implants made from ivory, shells & bone were used.Implants made from ivory, shells & bone were used.

 THE FOUNDATION PERIOD (1800-THE FOUNDATION PERIOD (1800-
1910)1910)

 The endosseous oral implantology truly began in the 19The endosseous oral implantology truly began in the 19thth
C.C.
 Maggilio in 1809 ,Maggilio in 1809 , a dentist at the university of Nancy , France, author ofa dentist at the university of Nancy , France, author of
the book called “the book called “THE ART OF THETHE ART OF THE DENTISTDENTIST”. The first reference to”. The first reference to
modern style implants.modern style implants.
 He has described the implant & placement.He has described the implant & placement.
 He made the tooth root shaped implant with 18 carat gold with threeHe made the tooth root shaped implant with 18 carat gold with three
prongs at the end to hold it in place in the bone . The implant was placed inprongs at the end to hold it in place in the bone . The implant was placed in
the freshly extracted socket site retained with the prongs. After the tissuesthe freshly extracted socket site retained with the prongs. After the tissues
healed the crown was attached with the help of post placed into the holehealed the crown was attached with the help of post placed into the hole
of root section of the implant.of root section of the implant.
 He placed the single stage gold implant.He placed the single stage gold implant.

 In mid 1800s advancement in the antiseptics & surgicalIn mid 1800s advancement in the antiseptics & surgical
techniques , there were documentation of implanted materials.techniques , there were documentation of implanted materials.
 W. J . YoungerW. J . Younger of San Francisco introduced operations inof San Francisco introduced operations in
United States. In 1893 he wrote that his operation hasUnited States. In 1893 he wrote that his operation has
successfully entered 8successfully entered 8thth
year of life.year of life.
 In 1886 HarrisIn 1886 Harris treated a Chinese patient in Grass valley ,treated a Chinese patient in Grass valley ,
California . He placed the tooth root shaped plantium postCalifornia . He placed the tooth root shaped plantium post
with lead coating , roughened to afford aretaining hold for nwwith lead coating , roughened to afford aretaining hold for nw
tissuses in the socket & artificial porcelain crown placed ,tissuses in the socket & artificial porcelain crown placed ,
lasted for 27 yrs Reported in Dental Cosmos in 1887.lasted for 27 yrs Reported in Dental Cosmos in 1887.
 InIn 1889 Edmunds1889 Edmunds of Newyork reported on March 12 ,1889of Newyork reported on March 12 ,1889
to the First District dental society of that city. He imlanted theto the First District dental society of that city. He imlanted the
metallic capsule made up of platinum foil covered with lead &metallic capsule made up of platinum foil covered with lead &
soldered with pure silver.soldered with pure silver.

 In 1888 BerryIn 1888 Berry reported about the root form implants made upreported about the root form implants made up
of lead.of lead.
 In 1890 , a Massachusetts ministerIn 1890 , a Massachusetts minister had his lower jawhad his lower jaw
resected & was restored with an extensive system of goldresected & was restored with an extensive system of gold
crowns soldered & joined to hinged device attached o thecrowns soldered & joined to hinged device attached o the
remaining dentition .remaining dentition .
 Znamenski in 1891Znamenski in 1891 reported on implantation mae ofreported on implantation mae of
Porcelain, guttapercha & rubber.Porcelain, guttapercha & rubber.www.indiandentalacademy.comwww.indiandentalacademy.com

 Bonwill in 1895Bonwill in 1895 reported on the implantation of one or tworeported on the implantation of one or two
tubes of gold or Iridium as a support for individual teeth ortubes of gold or Iridium as a support for individual teeth or
crown.crown.
 IN 1898 R. E PayneIN 1898 R. E Payne at the National Dental Associationat the National Dental Association
meeting gave the first clinical demonstration by placing themeeting gave the first clinical demonstration by placing the
silver capsule in the extracted tooth socket.silver capsule in the extracted tooth socket.

 PREMODERN ERA ( 1910-1930)PREMODERN ERA ( 1910-1930)

 The first two decades of 20The first two decades of 20thth
C. predominated by the cliniciansC. predominated by the clinicians
namely R.E Payne& E. J .Greenfield.namely R.E Payne& E. J .Greenfield.
 R. E .Payne presented his technique of capsule implantation atR. E .Payne presented his technique of capsule implantation at
the the clinics of Third international Dental Congress, reportedthe the clinics of Third international Dental Congress, reported
in the Dental Cosmosin 1901.in the Dental Cosmosin 1901.
 Technique- Extracting the root , enlarging the socket withTechnique- Extracting the root , enlarging the socket with
trephine, trial fiting of the capsule. He then placedgrooves ontrephine, trial fiting of the capsule. He then placedgrooves on
both sides of the socket & filled 2/3rds with rubber, fitted theboth sides of the socket & filled 2/3rds with rubber, fitted the
porcelain root into the capsule & set it wih guttapercha.porcelain root into the capsule & set it wih guttapercha.
 In 1903 Sholl in Pennsylvania , implanted apocelain tooth withIn 1903 Sholl in Pennsylvania , implanted apocelain tooth with
corrugated porcelain root.corrugated porcelain root.

 In 1913 Dr. Edward J. Greenfield came up with he surgicalIn 1913 Dr. Edward J. Greenfield came up with he surgical
method to prepare osteotomy in the healed boneusing trephine.method to prepare osteotomy in the healed boneusing trephine.
 He fabricated the hollow cylindrical basket root of 20 guageHe fabricated the hollow cylindrical basket root of 20 guage
iridioplatinum soldered with 24 carat gold .Precursor ofiridioplatinum soldered with 24 carat gold .Precursor of
hollow basket designhollow basket design
 Greenfield emphasised onGreenfield emphasised on
 The importancee of intimate contact between bone & implant.The importancee of intimate contact between bone & implant.
Hollow implants faciliteted growth of bone into implant bodyHollow implants faciliteted growth of bone into implant body
& secure it.& secure it.
 3 months period of unloading.3 months period of unloading.
 Implants failures because of infection.Implants failures because of infection.
 His techniques were simmilar to present concepts ofHis techniques were simmilar to present concepts of
osteotomy preparation, restoring after healing time.osteotomy preparation, restoring after healing time.

 Greenfield two piece basket imlpantGreenfield two piece basket imlpant

 InIn 1920s Leger- Dorez1920s Leger- Dorez developed expansible root implantwas comparabledeveloped expansible root implantwas comparable
to a concrete expansion bolt.to a concrete expansion bolt.
 SmolonSmolon described the implant as a four part device with the shaft buried indescribed the implant as a four part device with the shaft buried in
bone, broader uppermost potion resting near the alveolar crest . The shaftbone, broader uppermost potion resting near the alveolar crest . The shaft
had internal threads to receive asrew , fastening the neck into the shaft &had internal threads to receive asrew , fastening the neck into the shaft &
the lower most part of the shaft flared as the srew inserted . Then the partthe lower most part of the shaft flared as the srew inserted . Then the part
bearing the post for the prosthesis was attached.bearing the post for the prosthesis was attached.
 The histrical basis for the internal srws provided for the retention ofThe histrical basis for the internal srws provided for the retention of
prosthetic devices simillar to today’s implants.prosthetic devices simillar to today’s implants.
 Tomkin’s implnted porcelain teeth.Tomkin’s implnted porcelain teeth.
 Brill in 1936 inserted rubber pins in artificialy prepared sockets.Brill in 1936 inserted rubber pins in artificialy prepared sockets.

 THE DAWN OF THE MODERN ERATHE DAWN OF THE MODERN ERA
1935-19781935-1978

 Adams in 1937Adams in 1937 developed a submergible threaded cylindricaldeveloped a submergible threaded cylindrical
implant with round bottom , smooth gingival collar & ealingimplant with round bottom , smooth gingival collar & ealing
cap The ball head screwed to the root was used to retain ancap The ball head screwed to the root was used to retain an
overdenture.overdenture.
 The components designed to flex vertically or laterallyThe components designed to flex vertically or laterally
simillar to the IMZ intramobile element.simillar to the IMZ intramobile element.

 The modern era of implant dentistry most definitely began inThe modern era of implant dentistry most definitely began in
the late1930s with the work of Venable, Strock , Dahl ,the late1930s with the work of Venable, Strock , Dahl ,
Gershkoff & Goldberg.Gershkoff & Goldberg.
 Venable in 1937 developed the cast Co- Chr- Mo alloy knownVenable in 1937 developed the cast Co- Chr- Mo alloy known
as Vitalium.as Vitalium.
 In 1939 Alvin & Moses Strock used the Venable screw typeIn 1939 Alvin & Moses Strock used the Venable screw type
implant.implant.
 In 1940s Strock developed both endodontic & truly endostealIn 1940s Strock developed both endodontic & truly endosteal
dental implants.dental implants.

 In 1938 Stock placed the threaded vitallium implant into theIn 1938 Stock placed the threaded vitallium implant into the
extraction socket, the first long term endosseous implant.extraction socket, the first long term endosseous implant.
 It remained firm & assymptomatic for nearly 17 years..It remained firm & assymptomatic for nearly 17 years..
 He demonstrated that the Vitllium implants were wellHe demonstrated that the Vitllium implants were well
tolerated.tolerated.

 In 1940 Dahl in Germany developed Intramucosal orIn 1940 Dahl in Germany developed Intramucosal or
buttn implants – Mucosal inserts.buttn implants – Mucosal inserts.

 SUBPERIOSTEAL IMPLANTSSUBPERIOSTEAL IMPLANTS
 An implant structure that covers thealmost entire crestal surface ofAn implant structure that covers thealmost entire crestal surface of
maxillary & mandibular RAR underthe soft tissue to include themaxillary & mandibular RAR underthe soft tissue to include the
periosteum , with the four to six posts protruding out through gingiva andperiosteum , with the four to six posts protruding out through gingiva and
on it the complete denture will be attached.on it the complete denture will be attached.
 In 1943 Gustav Dahl placed the SP implant on maxillary RAR later onIn 1943 Gustav Dahl placed the SP implant on maxillary RAR later on
mandibularmandibular
 Dahl & Izikowitz described the frames placed around the teeth in partiallyDahl & Izikowitz described the frames placed around the teeth in partially
edentulous patients termed as SUPERPLANTS.edentulous patients termed as SUPERPLANTS.
 Gershkoff & Goldberg visited Dahl in Sweden & thus theconceptGershkoff & Goldberg visited Dahl in Sweden & thus theconcept
introduced in U.S.introduced in U.S.

FABRICATION OF SUB PERIOSTEAL IMPLANTFABRICATION OF SUB PERIOSTEAL IMPLANT
 Goldberg & Gershkoff methodGoldberg & Gershkoff method
 Make an impression of the mucosa covering the RARMake an impression of the mucosa covering the RAR
 Make model & wire template made for radiography.Make model & wire template made for radiography.
 Measurements of the soft tissue depth were derived from theMeasurements of the soft tissue depth were derived from the
radiography and model was carved & casted to produce theradiography and model was carved & casted to produce the
multifenestrated Co-Chr-Mo casting with four abutments.multifenestrated Co-Chr-Mo casting with four abutments.

 Berman introduced the Two stage surgical techniquefor subBerman introduced the Two stage surgical techniquefor sub
periosteal implant.periosteal implant.
 First step was a direct impression of the surgically exposedFirst step was a direct impression of the surgically exposed
bonebone
 Second was implanting the subperiosteal frame generatedSecond was implanting the subperiosteal frame generated
from the stone cast.from the stone cast.

 Weinberg sectionalWeinberg sectional
subperiosteal implant.subperiosteal implant.
 Lew developed modifiedLew developed modified
technique for fitting uppertechnique for fitting upper
implants by extendinng theimplants by extendinng the
implant frame further to theimplant frame further to the
periphery.periphery.

 Kieinschmidt developed anterior single sub periosteal implant.Kieinschmidt developed anterior single sub periosteal implant.
 Marziani reported on the fabrication of full upper & lowerMarziani reported on the fabrication of full upper & lower
subperiosteal implant.subperiosteal implant.
 Linkow developed a sub periosteal implant consisting ofLinkow developed a sub periosteal implant consisting of
three islands in front and behind the mental nerve to avoidthree islands in front and behind the mental nerve to avoid
damage from frame settling.damage from frame settling.
 CT scan imaging technique used to obtain three dimensionalCT scan imaging technique used to obtain three dimensional
replica of the mandible & CAD-CAM models used forreplica of the mandible & CAD-CAM models used for
fabricating the frame work.fabricating the frame work.
 Long term success only 50 to 60%.Long term success only 50 to 60%.

 In 1947, Formiggini developed aIn 1947, Formiggini developed a
double helix wire spiral implants madedouble helix wire spiral implants made
of stainless steel or tantalum. Two endsof stainless steel or tantalum. Two ends
of the wire were soldered together toof the wire were soldered together to
form apost or neck.form apost or neck.
 Chercheve Modified by increasing theChercheve Modified by increasing the
length of the neck to reduce the crestallength of the neck to reduce the crestal
forces & developed the double helixforces & developed the double helix
out of vitallium.out of vitallium.
 He developed the co ordinated systemHe developed the co ordinated system
of instrumentation for implantof instrumentation for implant
insertion.insertion.

 Marziani’s use of porcelain &Marziani’s use of porcelain &
acrylic roots to support fullacrylic roots to support full
dentures.dentures.
 In 1950 Lee’s Post design i.eIn 1950 Lee’s Post design i.e
central narrow post withcentral narrow post with
extentions for the blood & boneextentions for the blood & bone
forming elements to encompassforming elements to encompass
the major part of the implant.the major part of the implant.www.indiandentalacademy.comwww.indiandentalacademy.com

ONE STAGE ENDOSTEAL PINS, SCREWS, &ONE STAGE ENDOSTEAL PINS, SCREWS, &
CYLINDERSCYLINDERS
 The early 1960s marked the beginning of an active developmentThe early 1960s marked the beginning of an active development
al era in implant design.al era in implant design.
 Scialom developed a tantalum tripodal pinScialom developed a tantalum tripodal pin
 Three intersecting pins were joined by acrylic to support thThree intersecting pins were joined by acrylic to support th
crown. Difficulty in maintaining the trifurcation limited thecrown. Difficulty in maintaining the trifurcation limited the
comfortable survival.comfortable survival.

 In 1960 Onlay developedIn 1960 Onlay developed
Virilium posts placed intoVirilium posts placed into
endodonticaly treated teethendodonticaly treated teeth
extending beyond the apex.extending beyond the apex.

SCREW TYPE IMPLANTSCREW TYPE IMPLANT
 Tramonte introduced a stres resistant drive screw implant.Tramonte introduced a stres resistant drive screw implant.
 Meglan & Lehman reported on the expandable implants.Meglan & Lehman reported on the expandable implants.
 Lew introduced ascrew was aself tapping Vitallium implant withLew introduced ascrew was aself tapping Vitallium implant with
conventional threads & square post.conventional threads & square post.
 Muratori & Pasquallini introduced hollow cores along with the screwMuratori & Pasquallini introduced hollow cores along with the screw
threads.threads.
 The majority of these screw shaped implans were one piece & were notThe majority of these screw shaped implans were one piece & were not
submerged , did not osseointegrate .It ws emphasized that the fibrous perisubmerged , did not osseointegrate .It ws emphasized that the fibrous peri
implant membrane with its shck absorbing feature prefered than boneimplant membrane with its shck absorbing feature prefered than bone
fusing to implant.fusing to implant.

 In 1963 Dr. Linkow , American DentistIn 1963 Dr. Linkow , American Dentist
developed first screw type of implant –developed first screw type of implant –
Vent Plant.Vent Plant.
 This was the first self tapping , selfThis was the first self tapping , self
threading implant . It had an open cagethreading implant . It had an open cage
like design that went into bone first , withlike design that went into bone first , with
afew threads on solid body at the top. Heafew threads on solid body at the top. He
used Vitallium first latter on titanium.used Vitallium first latter on titanium.

BLADE IMPLANTSBLADE IMPLANTS
 Linkow blade implants invented in 1967.Linkow blade implants invented in 1967.
 Long thin blade that will be surgically inserte into the grooveLong thin blade that will be surgically inserte into the groove
in the bone .in the bone .
 Abutment projecting out from the blade to this crown orAbutment projecting out from the blade to this crown or
attachment for denture can be placed.attachment for denture can be placed.
 IT required the shared support of natural teeth also.IT required the shared support of natural teeth also.
 Restored within month so became most widely used in unitedRestored within month so became most widely used in united
states.states.
 Linkow modified the design configuration for broadLinkow modified the design configuration for broad
applicability in maxilla & mandible, narrow ridges.applicability in maxilla & mandible, narrow ridges.

 In 1970 Roberts & Roberts developed Ramus bladeIn 1970 Roberts & Roberts developed Ramus blade
implants .implants .
 It was to be positioned by anchoring distallyIt was to be positioned by anchoring distally
between the cortical plates in the ramus of thebetween the cortical plates in the ramus of the
mandiblemandible

 RAMUS FRAME IMPLANT devalopedby Roberts &RAMUS FRAME IMPLANT devalopedby Roberts &
Roberts in 1970 .Roberts in 1970 .
 The endosseous implant received stabilization from itsThe endosseous implant received stabilization from its
anchorage in ramus area bilaterally & in the symphysealanchorage in ramus area bilaterally & in the symphyseal
region.region.

TRANSOSTEAL IMPLANTSTRANSOSTEAL IMPLANTS
 In 1975 Small introduced the transosteal mandibular staple &In 1975 Small introduced the transosteal mandibular staple &
bone plate, a reconstructive device placed throhgh a submentalbone plate, a reconstructive device placed throhgh a submental
inision & attached to the mandible with multiple fixation &inision & attached to the mandible with multiple fixation &
two transosteal screws to support a full arch proshesis.two transosteal screws to support a full arch proshesis.
 Currently used for mandibullar prosthesis only.Currently used for mandibullar prosthesis only.
 He presented 16 yrs evaluationHe presented 16 yrs evaluation
 Cranin developed single transosteal implant.Cranin developed single transosteal implant.

 In 1970 Kawahara was developing a ceramicIn 1970 Kawahara was developing a ceramic
implant in Japan .implant in Japan .
 In 1975 first Aluminium oxide implant wasIn 1975 first Aluminium oxide implant was
placed.placed.
 In 1970 Grenoble placed Vitreous CarbonIn 1970 Grenoble placed Vitreous Carbon
implant .implant .

 CONTEMPORARY ORALCONTEMPORARY ORAL
IMPLANTOLOGY 1978 to presentIMPLANTOLOGY 1978 to present

 In 1978 conference held atIn 1978 conference held at
Harward , co- sponsored by NIH.Harward , co- sponsored by NIH.
 This was the milestone for furtherThis was the milestone for further
research.research.

 In 1976 Dr. Andre Schroeder in Switzerland first reported heIn 1976 Dr. Andre Schroeder in Switzerland first reported he
bone growth into titanium plasma sprayed hollowbone growth into titanium plasma sprayed hollow
endosseous implants.endosseous implants.
 At the same time , Prof. Willischulte in Germany reported theAt the same time , Prof. Willischulte in Germany reported the
success with immediate placement of Vitreous Carbon implantsuccess with immediate placement of Vitreous Carbon implant
after dental extraction & invented Frialit-2 implant.after dental extraction & invented Frialit-2 implant.

 Per-Ingvar Branemark developed the two stage threadedPer-Ingvar Branemark developed the two stage threaded
titanium endosseous root form implant in North America.titanium endosseous root form implant in North America.
 Branemark conducted the experiments called “ VitalBranemark conducted the experiments called “ Vital
microscopy” to study the interaction between blood & marrowmicroscopy” to study the interaction between blood & marrow
during healing . He inserted the titanium chambers into heduring healing . He inserted the titanium chambers into he
rabbit fibula. After the completion of the experiments i.e afterrabbit fibula. After the completion of the experiments i.e after
several months he failed to retrieve the titanium chambers.several months he failed to retrieve the titanium chambers.
 In 1960 at Gothenburg he continued the experimental studiesIn 1960 at Gothenburg he continued the experimental studies
on the blood cells & micro circulation in humans . Heon the blood cells & micro circulation in humans . He
inserted the titanium chambers into the underside of upperinserted the titanium chambers into the underside of upper
arms.arms.
 Branemark noticed that there was no inflammatory reactionBranemark noticed that there was no inflammatory reaction
to he titanium.to he titanium.


 He started thinking about the potential of titanium to act as anHe started thinking about the potential of titanium to act as an
anchorage point for load bearing medical applications such asanchorage point for load bearing medical applications such as
connecting artificial limbs so the spur for the next experimentconnecting artificial limbs so the spur for the next experiment
whether titanium can be used as a bridge in bone healingwhether titanium can be used as a bridge in bone healing
application.application.
 Concept of Osseo integration developedConcept of Osseo integration developed
 The first clinical trail was done in 1965.The first clinical trail was done in 1965.
 In 1971 surgical equipments.In 1971 surgical equipments.
 In May 1982 Dr. George Zarb organized the TorontoIn May 1982 Dr. George Zarb organized the Toronto
conference on osseointegration. Branemark presented Twoconference on osseointegration. Branemark presented Two
stage threaded root form implant along with the 15 yrsstage threaded root form implant along with the 15 yrs
research work & clinical trail.research work & clinical trail.

BRANEMARK SYSTEM COMPONENTSBRANEMARK SYSTEM COMPONENTS
 FIXTUREFIXTURE –made of pure titanium with machined threads on–made of pure titanium with machined threads on
outer &inner surface. The top of the fixture has hexagonalouter &inner surface. The top of the fixture has hexagonal
design & threads visible in the internal channel. The apicaldesign & threads visible in the internal channel. The apical
portion tapered with four vertical notches help to gather boneportion tapered with four vertical notches help to gather bone
particles into transverse hole to achieve bone anchorage.particles into transverse hole to achieve bone anchorage.
 COVER SCREW-COVER SCREW- seals the coronal potion of fixture duringseals the coronal potion of fixture during
theinterim period.theinterim period.
 ABUTMENTABUTMENT-- -made of titanium in a cylinder shape.the-made of titanium in a cylinder shape.the
apical portion has hexagonal shape to fit the coronal portionapical portion has hexagonal shape to fit the coronal portion
of fixture.of fixture.

 ABUTMENT SCREWABUTMENT SCREW – insert through the abutment &– insert through the abutment &
theads into the fixture to connect the two components . It hastheads into the fixture to connect the two components . It has
a silicone ring that provides the seal to prevent microa silicone ring that provides the seal to prevent micro
organisms passing into the fixture.the head of the abutmenorganisms passing into the fixture.the head of the abutmen
screw has smaller hexagonal shape wih threads machinedscrew has smaller hexagonal shape wih threads machined
inside smaller channel.inside smaller channel.
 GOLD CYLINDER-GOLD CYLINDER- made of gold , Pl, Pd. It is machined tomade of gold , Pl, Pd. It is machined to
fit the corinal portion of the abutment. It becomes integral partfit the corinal portion of the abutment. It becomes integral part
of final prosthesis.of final prosthesis.
 GOLD SCREWGOLD SCREW –inserted through the gold cylinder &–inserted through the gold cylinder &
threads into the abutment screw o connect the gold cylinder &threads into the abutment screw o connect the gold cylinder &
abutment.abutment.

IMZ IMPLANT SYSTEMIMZ IMPLANT SYSTEM
 Kirsch developed the IMZ implant system in 1974. SinceKirsch developed the IMZ implant system in 1974. Since
1978 in clinical use.1978 in clinical use.
 Intramobile cylinder endosseous two stage osseointegratedIntramobile cylinder endosseous two stage osseointegrated
implant with spherical base in conjunction with viscoelasticimplant with spherical base in conjunction with viscoelastic
intra mobile element , transfers the occlusal forces evenly tointra mobile element , transfers the occlusal forces evenly to
the surrounding bone implant interface & shock absorption.the surrounding bone implant interface & shock absorption.
 The polyoxymethylene & polyacetal used as IME insertedThe polyoxymethylene & polyacetal used as IME inserted
between osseo integrated implant & prosthetic suprastrcture.between osseo integrated implant & prosthetic suprastrcture.
 Available in 3.5 to 4mm diameter and 8,10,13,15mm length.Available in 3.5 to 4mm diameter and 8,10,13,15mm length.
 Surface coating may be titanium plasma spray or plasmaSurface coating may be titanium plasma spray or plasma
sprayed HA coated surface, highly polished titaniumsprayed HA coated surface, highly polished titanium
transmucosal implant extension for soft tissue adaptation.transmucosal implant extension for soft tissue adaptation.

LEDERMAN SCREW IMPLANTLEDERMAN SCREW IMPLANT
 In 1977 Dr. Philippe Lederman in collaboration with straumanIn 1977 Dr. Philippe Lederman in collaboration with strauman
co. developed the Titanium plasma spraed screw type implant.co. developed the Titanium plasma spraed screw type implant.
 In 1989 Lederman developed the New Ledreman screwIn 1989 Lederman developed the New Ledreman screw
implant Surface roughened by sand blasting & acid etching.implant Surface roughened by sand blasting & acid etching.

ITI BONE FIT IMPLANT SYSTEMITI BONE FIT IMPLANT SYSTEM
 Developed by ‘International Team for Implantology’.Developed by ‘International Team for Implantology’.
 Three different typesThree different types
 Single stage & two stage.Single stage & two stage.
 Transgingivally placed in healing phase so second surgicalTransgingivally placed in healing phase so second surgical
procedure for uncovering the omplant is avoided.procedure for uncovering the omplant is avoided.

THE HAND-TITANIUM IMPLANT SYSTEMTHE HAND-TITANIUM IMPLANT SYSTEM
 Inaugurated clinically in 1985 at Switzerland & now inInaugurated clinically in 1985 at Switzerland & now in
use world wide ( Lederman 1986).use world wide ( Lederman 1986).
 A conical, step- screw, pure Ti implant with self thread.A conical, step- screw, pure Ti implant with self thread.
 Length- 10 to 20mm.Length- 10 to 20mm.
 Diameter – 3.5 to 7mm.Diameter – 3.5 to 7mm.

 In early 1980s Tantum introduced Omni R implant -In early 1980s Tantum introduced Omni R implant -
A Ti root form implant with horizontal fins.A Ti root form implant with horizontal fins.
 Omni S implant – for placing into bone graftedOmni S implant – for placing into bone grafted
maxillary sinus.maxillary sinus.

 In 1983 EL Blasty & Kamel introduced the newIn 1983 EL Blasty & Kamel introduced the new
endosseous implant material i.e Poly acrylic acidendosseous implant material i.e Poly acrylic acid
reinforced with ceramic allumina particles 0.3reinforced with ceramic allumina particles 0.3
microns.microns.
 The hydrophilic matrix swells in contact withThe hydrophilic matrix swells in contact with
aqueous solution.aqueous solution.
 The gradual pressure on the surrounding boneThe gradual pressure on the surrounding bone
stimulates osseous activity.stimulates osseous activity.
 Implanted in canine, premolar sites wit promisingImplanted in canine, premolar sites wit promising
results.results.

CORE VENTCORE VENT
 Developed by Dr. GeraldDeveloped by Dr. Gerald
Niznick in 1986.Niznick in 1986.
 Screw type designs withScrew type designs with
perforaions or holow basketperforaions or holow basket
design made of Ti alloy.design made of Ti alloy.

ENDOPOREENDOPORE
 A root form dental implantA root form dental implant
developed by Doughlasdeveloped by Doughlas
et.al in 1996 made of Tiet.al in 1996 made of Ti
alloy & sintered with samealloy & sintered with same
alloy producing porousalloy producing porous
surface.surface.
 Biological & clinicalBiological & clinical
advantages.advantages.


STERI OSS SYSTEMSTERI OSS SYSTEM
 Introduced by DenarIntroduced by Denar
 Made p of 99.9% Ti, tapered apex thread design & the coronalMade p of 99.9% Ti, tapered apex thread design & the coronal
33rdrd
highly polished surface.highly polished surface.
 Available in 3.5 to 4mm diameter, length 12Available in 3.5 to 4mm diameter, length 12
mm,16mm,20mm,& miniseries8mm,10mm,12mm length.mm,16mm,20mm,& miniseries8mm,10mm,12mm length.

 1984 – CT scan.1984 – CT scan.
 Bone augmentation techniques.Bone augmentation techniques.
 1986 Tatum reported about Sinus lift / Bone graft antroplasty.1986 Tatum reported about Sinus lift / Bone graft antroplasty.
 1988 Nerve transposition1988 Nerve transposition
 1989 Pterygoid implants .1989 Pterygoid implants .
 1991 Guided tissue regeneration using Gore-Tex or1991 Guided tissue regeneration using Gore-Tex or
resorbable Vicryl-Mesh used to augment narrow & shallowresorbable Vicryl-Mesh used to augment narrow & shallow
ridges .ridges .
 1995 Distraction osteotomies & split ridge technique.1995 Distraction osteotomies & split ridge technique.

 The screw type implants fabricated by HydroxyThe screw type implants fabricated by Hydroxy
appatite based composites fabricated by mixing HAappatite based composites fabricated by mixing HA
with Al oxide coated Zr oxide powder & comparedwith Al oxide coated Zr oxide powder & compared
with Cp.Ti implants.with Cp.Ti implants.
 HA based composites showed better mechanicalHA based composites showed better mechanical
properties & bioactivity.properties & bioactivity.
 (Young Min Kong et.al 2002).(Young Min Kong et.al 2002).

 Development of Bioactive Alumina –based compositeDevelopment of Bioactive Alumina –based composite
by electrophoretic deposition method.by electrophoretic deposition method.
 Alumina is excellent biomaterial ,goodAlumina is excellent biomaterial ,good
biocompability , highly corrosion resistance, highbiocompability , highly corrosion resistance, high
wear resistance & strength.wear resistance & strength.
 Wollastonite has (CaO. SiO2) high apatite formingWollastonite has (CaO. SiO2) high apatite forming
ability deposited into the pores of foamed Alluminaability deposited into the pores of foamed Allumina
by Electrophoretic deposition.by Electrophoretic deposition.

 Historically dental restorations supported by OsseointegratedHistorically dental restorations supported by Osseointegrated
implants evolved asimplants evolved as
 Fully ed. Mandibular arch -1980Fully ed. Mandibular arch -1980
 Fully ed. Maxillary archFully ed. Maxillary arch
 Short span ed. Segment -1990Short span ed. Segment -1990
 Missing single tooth – 1990Missing single tooth – 1990
 1980s restorations were screw retained , 1990s cemented.1980s restorations were screw retained , 1990s cemented.

SummarySummary

 CONCLUSSIONCONCLUSSION

REFERENCESREFERENCES
 Block & Kent’s Endosseous Implants For MaxillofacialBlock & Kent’s Endosseous Implants For Maxillofacial
Reconstruction.Reconstruction.
 Elaine Mc Clarence ’s Close to the edge.Elaine Mc Clarence ’s Close to the edge.
 Hubertus Spikerman’s Color atlas of Dental medicineHubertus Spikerman’s Color atlas of Dental medicine
(Implantology).(Implantology).
 Malvin E. Ring’s Dentistry An Illustrated History.Malvin E. Ring’s Dentistry An Illustrated History.
 Sumiya Hobo’s oseointegration and occlusal rehabilitation.Sumiya Hobo’s oseointegration and occlusal rehabilitation.
 Ralph V. McKinney, Jr’s endosteal dental implants.Ralph V. McKinney, Jr’s endosteal dental implants.
 ADA council on scientific affairs Dental endosseous
implants.An update. JADA, Vol. 135, January 2004.

 Richard M. Sullivan, Implant Dentistry and the Concept of Osseointegration: A
Historical Perspective .(2001) Journal of the California Dental Association.
 Douglas A. Deporter “simplifying the treatment of edentulousness” JADA Vol
121sept 1996:1343
 Young-Min Kong, Hydroxyapatite-Based Composite for Dental Implants: an In
Vivo Removal Torque Experiment. J Biomed Mater Res (Appl Biomater) 63: 714–
721, 2002
 M. A. EL BASTY and I. L. KAMEL.The Development of a Novel Tooth-root
Implant Material. J Dent Res 62(6):733-737, June 1983

 ss

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