History and evolution of dental implants

INDIAN DENTAL ACADEMY
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CONTENTS
INTRODUCTION
TERMINOLOGY
HISTORY OF IMPLANTOLOGY
 The ancient era
 The Medieval period
 The foundational period
 The Premodern era
 The dawn of the modern era
 Contemporary oral implantology
THE FUTURE
REVIEW OF LITERATURE
CONCLUSION
REFERENCES

INTRODUCTION
 Loss of teeth, eventual edentulism, and wearing of
complete dentures have been part of expected course of
aging by general population.
 Dental implants are not new to dentistry, They have been
reported as far back as the early Egyptians
 Incidence of edentulism in western world has posed
challenge to Prosthodontists & Oral surgeons, encouraging
them to devise acceptable prosthetic results for patients.

IMPLANT:- Any object or material, such as an alloplastic
substance or other tissue, which partially or completely
inserted or grafted into body for therapeutic, diagnostic,
prosthetic or experimental purposes.

DENTAL IMPLANT - A prosthetic device or alloplastic
material implanted into oral tissues beneath the mucosal
or periosteal tissues, and onor with in the bone to
provide retention and support for fixed or removal
prosthesis.

 The ancient era (through AD 1000).
 The medieval period (1000-1799).
 The foundational period (1800-1910)
 The premodern era (1910-1930)
 The dawn of the modern era (1930-1978)
 Contemporary oral implantology (1978 to
present)
HISTORY OF IMPLANTOLOGY:

ANCIENT ERA - 1000 A.D
HISTORY TRACED IN MIDDLE EAST
In 1862 GAILLARDOT excavated a grave site near
ancient city in sidon. Here he discovered a prosthodontic
appliance dating to 400B.C., consisting of four natural
teeth holding between them 2 carved ivory teeth.

The earliest recorded implant specimen is from 600A.D
from the Mayan civilization in south America.

HISTORY TRACED IN THE EGYPTIAN DYNASTIES
 Evidences have shown the implantation of animal teeth
& artificial teeth carved of ivory .

 In 1981 evidences of oldest dental implant was found in
the Kalavak Necropolis, near Izmir , Turkey.
 The discoveries were dated back to 550 B.C . A canine
tooth like object made of calcite having hardness similar
to natural teeth showing wear on the chewing surface &
secured with gold wires wrapped around the neck of
adjacent teeth.

 In 1931 Wilson Popenoe discovered a skull in the
Ulua river valley of Honduras , dating to the period 600
A.D . Skull had an artificial tooth replacing lower left
lateral incisor, carved of a dark stone . Radiographs
showed the evidence of compact bone around the
implant.

MEDIEVAL PERIOD (1000-1799 A.D)
 Albucasis de Condue ( 936- 1013 A.D) an Arab
surgeon described the transplantation procedures . He
attempted to use ox bone to replace missing teeth.

 In Japan in the 15th
& 16th
Centuary Wooden dowel &
crown prosthesis was designed . The pin inserted into
the root canal of non vial teeth.
 This was an early endodontic implant – supported
prosthesis.

 Charles Allen in 1687 gave the first written work on
dentistry.
 He described the replanting of tooth into the same
patient.
 Allen emphasized on transplantation of tooth using
animal tooth.
 In European sphere transplantation became the common
practice
 The tooth transplant could lead to transfer of diseases .
 Implants made from ivory, shells & bone were used.

 Ambroise Pare, a French physician , a surgeon to four
kings of France.
 He replaced the missing teeth with implants made up of
bone & ivory .
 He successfully replaced missing tooth of Princess by
transplanting.

1728 – piere fauchard given a protocol for
reimplantation of teeth that recipient be young in age
with healthy gingiva and transplant be completed as
early as possible

THE FOUNDATIONAL PERIOD (1800-1910):
Beginning of Endosseous oral implantology
1809 - Maggioli , inserted a gold implant into a freshly
extracted site.
1886 - Younger , artificial socket
1887 – Harris and berry , porcelain crowns upon platinum
posts

1888 - berry used lead implants
1889 – edward , platinum roots
1898 - R.E.payne places silver capsule in the tooth socket

Edmunds of newyork city- reported on march 12,1889- to
the first district of dental society of that city, the
implantation of metallic capsule in the space occupied by
upper right first premolar.
In 1890, ZAMENSKI reported the implantation of teeth
made of porcelain, gutta-percha, and rubber.

THE PREMODERN ERA (1910-1930):
The first two decades of 20th
C. predominated by the
clinicians namely R.E Payne& E. J .Greenfield.
R. E .Payne presented his technique of capsule
implantation at the clinics of Third international Dental
Congress, reported in the Dental Cosmos in 1901.

Technique - Extracting the root , enlarging the socket with
trephine, trial fitting of the capsule. He then placed
grooves on both sides of the socket & filled 2/3rds with
rubber, fitted the porcelain root into the capsule & set it
with gutta-percha.
In 1903 - Sholl in Pennsylvania , implanted porcelain tooth
with corrugated porcelain root.

In 1913 Dr. Edward J. Greenfield came up with the surgical
method to prepare osteotomy in the healed bone using
trephine.
He fabricated the hollow cylindrical basket root of 20 gauge
iridioplatinum soldered with 24 carat gold.

CONTRIBUTION OF GREENFIELD
 First to document an implantation procedure in the
scientific literature.
 considered implant dentistry to be the “missing link”
 emphasized the importance of sterile procedure
 concept of “Osseointegration” is discussed
 Greenfield manufactured an artificial root of 20 gauge
iridoplatinum wire soldered with 24-carat gold.

THE DAWN OF THE MODERN ERA (1935-1978)
 METAL IMPLANT devices of gold, lead, iridium,
tantalum, stainless steel & cobalt alloy were developed in
early 20th
century.
 In 1936- BRILL inserted rubber pins in artificial prepared
socket.
 In 1937 VENABLE developed the cast cobalt-chromium-
molybdenum alloy now known as vitallium.

Adams in 1937 developed a submergible threaded
cylindrical implant with round bottom , smooth gingival
collar & healing cap. The ball head screwed to the root
was used to retain an overdenture.

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

 In 1943 Dahl in Germany developed Intramucosal or
button implants – Mucosal inserts.

In 1947, Formiggini developed a
single helix wire spiral implants
made of stainless steel or
tantalum.
Chercheve Modified by increasing
the length of the neck & double
helix out of vitallium.

 In 1950 Lee’s Post design i.e
central narrow post with
extensions.

HISTORY OF OSSEOINTEGRATION
 1952: Young Orthopedic Surgeon Branemark
 Lab Of Vital Microscopy University Of Lund, Sweden
 Healing Of Bone Marrow Defects At Microscopic Level In
Fibula Of Rabbits

At The End Of The Study, Titanium Microscopes
Placed In Rabbits Fibula Were Not Retrievable
Ist Evidence Of Bone Fusing With Metal Genesis Of
Osseointegration

Anchorage Capacity Of The Integrated Implants Or Fixtures
Was Shown By Suspending The Dog Via Wires Connected
To The Fixtures

 1965, the Swedish team felt ready to apply its
findings to human patients.
 planned to work with knee and hip joint surgeries.
 34-year-old man who had been born with a deformed
chin and jaw.
 Brånemark inserted four titanium fixtures into the man’s
mandible, and several months later he used the fixtures
as the foundation for a fixed set of false teeth. The
fixtures survived,the patient’s life was transformed.
 Brånemark resolved to develop more techniques for
dealing with dental rehabilitation.

SUBPERIOSTEAL IMPLANTS:
 In 1943 Gustav Dahl
placed the SP implant on
maxillary RAR later
on mandibular.

FABRICATION OF SUB PERIOSTEAL IMPLANT
 Goldberg & Gershkoff method
 Make an impression of the mucosa covering the RAR
 Measurements of the soft tissue depth were derived from
the radiography and model was carved & casted to produce
the multifenestrated Co-Chr-Mo casting with four
abutments.

 Berman introduced the Two stage surgical technique for
sub periosteal implant.
 First step was a direct impression of the surgically
exposed bone
 Second was implanting the subperiosteal frame
generated from the stone cast.
 reported on the fabrication of full upper & lower
subperiosteal implant.

Linkow developed Sub periosteal implant consisting of
three islands

ENDOSTEAL IMPLANTS
 Strock developed truly endosteal dental implants in the
1940s and was first to present the Histologic evidence of
Osseointegration.
 Zepponi, developed a cast spiral implant.

50s and 60s50s and 60s
 was a period of trial and error
 dominated by the work of linkow
 the linkow blade or linkow blade vent, was introduced in
1967 - an implant that dominated the 1960s, 70s and
early 80s
 Founded the American academy of implant dentistry.

 In 1960s SCIALOM- described the use of tripoidal
tantalum pin endosseous implants.
 They are made up of a tantalum tripoidal pin

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

 In late 1960s ROBERTS developed ramus blade
endosseous implant.
 In early 1970s GRENOBLE introduced vitreous carbon
implants. it was first placed in the canines.
 Based upon biocompatibility and efficacy studies, human
clinical studies began on the use of this implant in
late1970s.

Blade implants
Linkow blade implants invented in 1967.
Restored within month so became most widely used in
united states.
Linkow modified the design configuration for broad
applicability in maxilla & mandible, narrow ridges.

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

CONTEMPORARY ORAL IMPLANTOLOGY (1978 TO
PRESENT)
 Originates with the 1978 conference held at Harvard .
 Results of about 30 years of experimental research in
Sweden were finally put for peer review in 1981.
 This implant was first known as Biotes and then as
the Nobelpharma implant.

 In early 1980s TATUM introduced the omni R implants.
this is a titanium alloy root form implant.
 In1980s DRISKELL introduced the Stryker root form
endosseous implant made of titanium alloy and
hydroxyapatite coating.
 In the 1980s cylindrical plasma spray titanium and
hydroxyapatite coated implants were introduced.

IMZ IMPLANT SYSTEM
 Kirsch developed the IMZ implant system in 1974.
Since 1978 in clinical use.
 Surface coating plasma sprayed HA coated surface.
 Elastic intramobile element – PDL

Distal free end situations

LEDERMAN SCREW IMPLANT
 In 1977 Dr. Philippe Lederman in collaboration with
strauman co. developed the Titanium plasma
sprayed screw type implant.
 In 1989 Lederman developed the New Lederman
screw implant Surface roughened by sand blasting &
acid etching.
 Self tapping, less traumatic
 used mainly in edentulous mandible

ITI BONE FIT IMPLANT SYSTEM
 Developed by ‘International Team for Implantology’.
 Single stage & two stage.
 Supragingivally placed
 micro gap

THE HAND-TITANIUM IMPLANT SYSTEM
 Clinical use since 1985 at Switzerland & now in use
world wide ( Lederman 1986).
 A conical, step- screw, pure Ti implant with self
thread and self tapping
 Edentulous mandible may be loaded with an over
denture immediately

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

MINI DENTAL IMPLANT
 In 1985 Victor Sendax developed MDI.
 Ultra – small diameter 1.8 mm, biocompatible Ti alloy
implant screws.
 Bulard added single one piece `O- ball’ design .

ENDOPOREENDOPORE
 A root form dental implant
developed by Doughlas et.al
in 1996 made of Ti alloy &
sintered with same alloy
producing porous surface.

Endopore’s advantages include:
 a secure, three-dimensional interlocking interface with
bone
 predictable and minimal crestal bone remodelling
 greater surgical options with shorter implant lengths
an uncomplicated surgical sequence
 minimal instrumentation and inventory

Outstanding Success Rates
Endopore’s high rates of success are due to the
Endopore’s engagement with the alveolar crest by
cortical bone ingrowth into the implant’s interconnecting
pores.
When the implant is placed into function, occlusal loads
transferred to the crest stimulate further cortical bone
development in accordance with Wolff’s law.

NOVUM CONCEPT
 Branemark developed the concept of providing a
new set of teeth for the mandible in a single day.
 Clinically implicated in 1996.

Three titanium fixtures inserted , mucosa is closed &
base plate is placed over the fixtures & then the
prosthesis is placed.

ZYGOMATICUS FIXTURES
 Branemark.
 The long fixture can be anchored in zygoma by
approaching through the sinus .
 Severely resorbed maxilla.

BICORTICAL SCREW IMPLANTBICORTICAL SCREW IMPLANT
 The cost and time factor for healing and
tissue integration
 Good bone in terms of both quality and
quantity have been drawbacks of
implant dentistry techniques.
 Bicortical implants minimize these
drawbacks and provide an alternative
treatment of choice.

 The additional stability provided by this screw allows for
immediate loading at the time of implant placement.
 they are cost-effective, thus enabling dentists to select
the optimal implant for each individual indication.
 They are mainly designed for maxillary and mandibular
anterior regions although there have been claims of their
placement in the premolar region without complications.

OSTEOPLATE 2000
 Atrophic RAR
 The conical plate with
shoulder width 1.3 mm &
base 0.9 mm.

The Essential Features
Indication in cases of extended advanced atrophy, where
other implant systems cannot be applied. The implant
body design with small shoulder width allows insertion by
slight bone expansion,favoring early direct bone contact
Unique implant system, avoiding bone augmentation in
most cases,even in severely atrophied jaws
In cases of sinus lift, the OSTEOPLATE is often used as
an instant implant with simultaneous augmentation, even
after extraction in the subantral region

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

SUMMARY
 Before 1000 A.D tooth carved of stones , calcite, ivory
were implanted.
 In the 1000 -1799 A.D mainly allotransplantation.
 In the 1800-1910 period beginning of root form
endosseous implant of Au, Pt .
 In the 1910-1935 Greenfeild designed hollow basket
implant.
 In 1935- 1978 Root form implants of the pin & screw
type, Sub periosteal , Ramus blade, Ramus frame,
Transosteal.
 In 1978 Branemark developed the Titanium implants,
latter on different surface treated Ti implants developed.

THE FUTURE
The future now seems to be looking to
Nanotechnology, as illustrated by the recent
introduction of a chemically-modified implant surface,
or biotech concepts such as the incorporation of bone
morphogenetic proteins onto the implant surface.

Certainly it seems there is more development &
evolution to come,which will ultimately add to history of
these small metal devices, but only until such time as the
very notion of screwing metal into bone becomes
historical itself , which it surely will as genetic engineering
gathers pace.

REVIEW OF LITERATURE
Twenty years of progress in implant prosthodontics.
J Prosthet Dent. 2002 Jul;88(1):89-95.
Prosthodontic focus on the restoration of
osseointegrated dental implants has evolved
dramatically in the last 20 years. Many of the original
guiding principles for restoring implants have
changed and/or disappeared altogether, and new
ideas have taken their place. It is appropriate that this
evolution be examined with a 2-fold focus.
First, the art and science of prosthodontics as it
relates to dental implants today is the result of very
real and important lessons learned during the past 2
decades.

 Second, an appreciation of the history of implant
prosthodontics as it relates to osseointegration gives
insight into the future direction of research and clinical
exploration aimed at continually improving the state of
the art and, ultimately, the quality of care provided to
patients.

Satisfaction with dental implants: Implant Dent. 2005
Dec;14(4):399-406.
Recent years have witnessed a consistent trend toward the
introduction of patient assessment of different treatment
outcomes in dental practice. Patient satisfaction with dental
implants was considered among these treatment modalities.
95 % of the patients were satisfied with implant treatment

The role of dental implants in the future. J Am Dent
Assoc. 1992 Jan;123(1):36-42.
Osseointegration's documented success allowing
bone and mucosal tissue to tolerate a titanium
implant has dramatically expanded the possibilities of
dental care. We can now replace extracted teeth with
implants
There is much interest in quicker procedures,
shorter healing times or other materials to see if they
can be as successful as CP titanium. Some may
prove to be so.
In any case, osseointegration has had as much
impact on 20th century dentistry as local anesthetics,
fluorides and the airotor. Our practices and curricula,
are changing to remain contemporary and ready for
the 21st century.

The importance of dental implants. Gen Dent. 2001
Jan-Feb;49(1):38-45.
Implant dentistry has evolved into the mainstream
of restorative practices all over the world.
Maintenance of bone after tooth loss to improve or
maintain facial esthetics and improved retention,
function, and performance of removable restorations
are only some of the advantages for the edentulous
patient.
No longer are implants considered only when
traditional restorations cannot be fabricated.
Evidence-based reports indicate implant restorations
last longer than those on teeth and the abutment
teeth are at less risk of loss or complication.

CONCLUSION
In discussing the evolution of implants, one must consider
the objectives of
 The use of the dental implant, the nature of its design,
 The biocompatibility of materials with the oral
environment,
 Research data, and
 The long-term clinical trials
which have influenced the developments of such
implants.

REFERENCES
1.Dental Implants The Art and Science, Charles A .
Babbush.
2.Implants and Restorative Dentistry Carl . E . Misch.
3. Hubertus Spikerman’s Color atlas of Dental medicine
(Implantology).
4. color atlas of oral implantology - Norman cranin
5. Introducing dental implants – john a hobkirk

6. Twenty years of progress in implant prosthodontics.
J Prosthet Dent. 2002 Jul;88(1):89-95.
7. Satisfaction with dental implants: a literature review.
Implant Dent. 2005 Dec;14(4):399-406.
8. The role of dental implants in the future. J Am Dent
Assoc. 1992 Jan;123(1):36-42.
9. The importance of dental implants. Gen Dent. 2001 Jan-
Feb;49(1):38-45.

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History and evolution of dental implants

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