This document provides information on dental implants, including: 1. It discusses the history of dental implants from early examples in ancient civilizations to modern developments. Key contributors and their innovations are highlighted. 2. Types of dental implants are classified based on several factors such as placement location, shape, material, surface properties, and surgical procedure. Characteristics of different bone densities that impact implant placement are also described. 3. Osseointegration and factors influencing the bone-implant interface like implant design, surface properties, and surgical technique are explained in detail.

1. DENTAL IMPLANTS
SANGEETA ROY

2. INTRODUCTION
• Dental Implant:- “Agraft or insert set firmly or deeply into
or onto the alveolar process that may be prepared for its
insertion"

3. HISTORY 1. First evidence in Incas &
Mayans(600 BC)
2. 2500 BC Egyptians nailed
Copper studs with seashells
(carving like teeth)
3. 1809-Maggiolo-Gold Implant
4. 1913 FIRST Implant system by
greenfield
5. 1939-Strock-Vitallium screw in
root form
6. 1943- Dahl- Intramucosal
implant (Button insert)

4. 7. 1946- Goldberg & Gershkoff-
Subperiosteal Implant
8. 1964- Linkow- Blade implant
9. 1970- Roberts- Ramus implant
10. Per Ingvar Branemark- 1965- 1st
used pureTi implant
1982- osseointegration
proposed
11. 1988- National institute of
health recognized dental implant
subperiosteal
Blade
Ramus

5. INDICATION
1. Complete denture patient with
advanced residual ridge
resorption
2. Partially edentulous where RPD
is contraindicated (i.e. reduced
masticatory efficacy)
3. Single tooth replacement

6. CONTRAINDICATION
• Uncontrolled or controlled
diabetes/ medically
compromised
• Smoking
• Chronic steroid therapy.
• alcohol abuse
• High dose irradiation
• Pathologic conditions of the hard
and soft tissues
• Presence of untreated or
unsuccessfully treated
periodontal diseases.

7. ADVANTAGE 1. Preservation of bone
2. Improved function
3. Aesthetic
4. Stability & retention
5. Comfortable to patient

8. DISADVANTAGE
1. Expensive
2. Cant be used in medically
compromised patient
3. Longer duration of treatement
4. Anatomic limitation

9. RATIONALE 1. Loss of tooth cause atrophy of
surrounding bone, Dental
implant maintain the bone
levels by applying direct forces
on bone.
2. Allow the pt to use there
muscles of mastication, prevent
atrophy of muscles
3. Closest replacement of natural
teeth- boost self confidence
4. Becomes a part of body after
osseointegration

10. 1. IMPLANT BODY( FIXURE)
PARTS OF
IMPLANT
Crest module
Body
Apex region

11. 2. HEALING SCREW( COVER
SCREW): prevent growth of tissue
over implant edge.
given during first stage surgery
3. HEALING CAPS( GINGIVAL
FORMER): projected into oral
cavity, prevent overgrowth of tissue
given after healing in second stage
surgery

12. 4. ABUTMENT: For retention of
prosthesis, resemble prepared
tooth.
may be: screw retention,
cement retention, to retain
Removable prosthesis

13. CLASSIFICATION
• DEPENDING ON PLACEMENT
WITHINTHETISSUE
1. Subperiosteal: receive primary
bone support resting on it
2. Transosteal: penetrate both
cortical plate & passes through
entire thickness of alveolar
bone
3. Endosteal: penetrate only one
cortical plate
Basal implant : if take support from
basal bone

14. Endosteal implant Root form( vertical )
Cylindrical : microscopic retention
Press fit form
Screw root form( threaded)
Combination
Plate form( horizontal)
Flat & narrow in facio-lingual direction

15. 4. Ramus frame
5. Intramucosal
6. Endodontal

16. • DEPENDING ON SHAPE
1. Screw form
2. Bullet shaped
3. Basket form
4. Root form
5. Plates / blades
Bullet shaped
Basket shaped
Blade form

17. • DEPENDING ONTHE MATERIAL USED
1. Metallic & metallic alloy
2. Non metallic
3. Polymer
4. Composite
Titanium
Silver
Co-Cr-Mo
Fe- Cr- Ni
Ti- Al-VnCeramic HA
Al- oxide
Carbon
HA
Titanium
Ceramic Carbon

18. • DEPENDING ON REACTIONTO
BONE
1. Biotolerant : Polymers
2. Bioinert :Ti , Zirconia
3. Bioactive : Glass ceramic

19. • BASED ON MACROSCOPIC
BODY DESIGN
1. Hollow
2. Cylindrical
3. Vented
4. Threaded

20. • BASED ONTHE SURFACE
1. Machined surface
2. Textured surface (Acid etched )
3. Coated surface

21. • DEPENDING UPON
SURGICAL PROCEDURE
1. Single stage surgery procedure
2. Two stage surgery procedure
3. Direct single stage

22. • DEPENDING UPON
HISTOLOGICAL FEATURES
1. Osseo integration
2. Fibro-osseous integration

23. COMPONENTS
OF IMPLANT
DESIGN
• DIAMETER: ranging from 1.2-
2mm for mini implants upto 7
mm for wide diameter implants
 min 3.25 mm diameter is
required for strength
Most implants are of 4mm
diameter
• LENGTH: distance between
implant platform & apex
Commonly 8-13 mm

25. BASIC THREAD TERMINOLOGY

26. IMPLANT ABUTMENT
ATTACHMENT

27. SURFACE
MODIFICATION
• Passivation
• Ion implantation
• Surface texturing

28. BONE
CLASSIFICATION • MISCH’S CLASSIFICATION (based
on bone density)
• D1: dense cortical bone
• D2: thick dense to porous
cortical bone on the crest and
coarse trabecular bone within.
• D3: thin porous cortical bone on crest
and fine trabecular bone within.
• D4: fine trabecular bone
• D5: immature, non-mineralized bone.
• D1: > 1250 HU; D2: 850 to 1250 HU;
D3: 350 to 850 HU; D4: 150 to 350
HU; and D5: < 150 HU.

29. IMPLANT –
BONE
INTERFACE
• There are two basic
theories regarding the
bone-implant interface.
a)Fibro-osseous integration
b) Osseointegration
• Greek word osteon: bone,
and the Latin integrare : to
make whole.

30. FACTORS
AFFECTING
BONE
IMPLANT
INTERFACE
• Implant biocompatibility
• Implant surface/dimension
• Implant bed
• Loading condition
• Primary implant stability
• implant length and diameter.
• Surgical technique
• Bone quality and quantity

31. Implant
biocompatibility
• Materials used are:
• Cp titanium (commercially pure
titanium)
• Titanium alloy (titanium-
6aluminum-4vanadium)
• Zirconium
• Hydroxyapatite (HA), one type of
calcium phosphate ceramic
material

32. • Implant surface
• Pitch, is an important factor in implant
osseointegration.
• Increased depth between individual threads allows for
improved contact area between bone and implant.
• Moderately rough surfaces with 1.5µm also, improve
contact area between bone and implant surface.
• Reactive implant surface by anodizing (Oxide layer),
acid etching or HA coating enhanced osseointegration
• Implant bed

33. Primary
implant
stability
• micromotion of less than 30 μm
– no effect on osteointegration
• adequate‟ insertion torque
• the additional torque used to
secure or evaluate fixation of an
implant in
• bone (30-35Nw)
• But may actually result in
pressure necrosis and/or increase
the strain magnitude at the
interface and therefore increase
the amount of damage.
• implant length - > length better
successrate
• less than 10 mm – 50% failure

36. DISTANCE
BETWEEN
TWO
IMPLANTS

37. Surgical technique • 47°C at less than 1 minute to
avoid overheating the bone The
Heat generated is related to
• The presence and temperature
of irrigation
• Amount of bone being prepared
• Drill sharpness and design
• Time of preparation
• Depth of the osteotomy
• Pressure on the drill
• Drill speed
• Variation in cortical thickness.

38. Drill speed
• The speed of drills may be adjusted in relation to the quality of the bone being
prepared.
• D3 – 800 rpm
• D1- 2500 rpm proceed without exerting excessive pressure .
• Time of preparation
• pause approximately every 5 to 10 seconds.
• Pressure on the drill
• The average force placed on a hand piece during preparation of an osteotomy is
1. 2Kg. Enough pressure should be used to proceed at least 1 mm every 5
seconds

39. Bone quality
and
quantity
• The lower the modulus and the
less amount of bone–implant
contact will be there
• These factors are critically
important in relation to the
success or failure of
osseointegration
• Based on the above, there is a
general agreement among
clinicians that the mandibular
interforaminal area contains the
best qualitybone

40. OSSEOINTEGRATION
• Branemark in 1982 proposed that
implants integrate with bone
such that the bone is laid very
close to the implant material
without an intervening
connective tissue.
• Osseointegration is defined as “
the process and resultant
apparent direct connection of the
endogenous material surface &
the host bone tissues without
intervening connective tissue.”

42. • To obtain a successful osseointegration
Branemark and coworkers proposed
numerous factors.
• According to the proponents the oxide
layer should not be contaminated or
else inflammatory reaction follows
resulting in granulation tissue
formation.
• The temperature during drilling should
be controlled by copious irrigation, if
not can inhibit alkaline calcium synthesis
there by preventing osseointegration.
• The first month after fixture insertion is
the critical time period for initial healing
period.When loads are applied to the
fixture during this period primary
fixation is destroyed.

43. FIBRO-OSSEOUS
INTEGRATION
• CharlesWeiss, 1980’s stated that
fibroosseous ligament is formed
between the implant & the bone
& this is equivalent to PDL found
in gomphosis.
• Fibroosseous integration may
show initial success but failed to
show long term stability.

44. OSSEOINTEGRATION
VS BIO INTEGRATION • Meffert et al, (1987) redefined and
subdivided the term
osseointegration into “adaptive
osseointegration” and
“biointegration”.
• “Adaptive osseointegration” has
osseous tissue approximating the
surface of implant without apparen
soft tissue interface at the light
microscopic level.
• “Biointegration” is a direct
biochemical bone surface
attachment confirmed at the
electron microscopic level.

45. • Dr.charlesWeiss, stated that the collagen fibers invest the implant,
originating at the trabeculae of cancellous bone on one side,
weaving around the implant, and reinserting into a trabeculae on the
other side
• no real evidence to suggest that these fibers functioned in the mode
of periodontal ligament.
• the forces applied resulted in widening fibrous encapsulation,
inflammatory reactions, and gradual bone resorption there by
leading to failure.

46. Immediate
loading
• Implantplacement with primary
stabilityand prosthetic loading
with a provisional prosthetic
tooth at the same clinical visit or
With in 2 wks

47. Early
loading
• Implants placed with primary
stability and loaded with a
provisional prosthesis at a
subsequent clinical visit .
• should follow the onset of
osteogenesis since bone
formation is enhanced by
mechanical stimulation.
Therefore, early loading should
occur only after approximately 3
weeks of healing

48. Conventional
loading
• Implant placement (typically
achieving primary stability) and
healing for 3 to 6 months in a
submerged or non-submerged
mucosal orientation.
• This time frame reflects the
requirement for osteogenesis
and woven bone remodelling to
load-bearing lamellar bone and
acknowledges the original
recommendations of Brånemark
.

49. DIAGNOSIS
• Clinical examination of the
jawbone consists of palpation and
probing through the soft tissue
(intra oral bone mapping) to
assess the thickness of the soft
tissue at the proposed surgical
site.
CLINICAL
RADIOGRAPHICAL

50. Radiographic
analysis
• Types of imaging modalities:
• Periapical radiograph
• Occlusal
• OPG
• Cephalometric
• CT – 3 dimentional
• CBCT

51. • Phase 1:
• Pre surgical imaging:
• Identify disease
• Determine bone quality and quantity
• Determine implant position and orientation
• Phase 2:
• Surgical and intra operative imaging:
• Focused on assisting in surgical and prosthetic
intervention in pt
• Phase 3:
• Post prosthetic implant imaging –
• to evaluate long term maintenance of implant
and function

52. IMPORTANCE OF BONE
DENSITY

53. Type advantage disadvantage
D1
Anterior mandible
, 5 months healing time
dense lamellar bone with
complete haversian
systems
Less stresses -near crest
More BIC
fewer blood vessels
slower rate of 0.6 um /day
more difficult to prepare
Bone is easily overheated
D2-anterior mandible, followed by
the posterior mandible. Occasionally
ant .maxilla
bone healing within 4 month
bone provides excellent
BIC
intrabony blood supply –
reduce overheating
Improve primary stability
due to apical engage
Stress - around the crest greater
magnitude
D3- ant- maxilla post.either arch
TPS/HA
Maximum use of bone width
May need sinus grafting,additional
implant
Minimal osteotomy
Good blood supply
the stripping of the thin facial plates
during the osteotomy
More delecate to manage
less than 1500 rpm
<50% BIC
6month healing
D4-posterior maxilla
Need bone grafting
Maximum use of bone length
little or no cortical crestal bone
<25% BIC
to 8 months of undisturbed healing

54. IMPLANT SITE
PREPARATION
• Alveolar ridge reconstruction with
preprosthetic surgery
• Alveolarbone preservation
following tooth extraction
(immediate implants, GBR,
osseous grafting etc.)
• Sinus lift/ grafting procedures
• Alveolar ridge augmentation
• Implant site development using
ridge splitting technique
• Alveolar ridge development using
distraction osteogenesis
• Growth factors for implant site
development

56. TREATMENT
PLANNING 1 .prosthesis design
2. patient force factors
3. Bone density/availability in
edentulous site
4. Key implant position and number
5 .Implant size
6.Implant design

57. • PROSTHESIS DESIGN: Implant supported denture , ovrer denture,
fixed denture
• PATIENT FORCE FACTORS: parafunctional habit (bruxism,
clenching)
• the force applied to the restoration differs by magnitude ,
duration, type and pre disposing factor may need
1) additional implants that are wider in diameter
2)proper incisal guidance
3) narrow posterior occlusal table
4)enameloplasty of opposite natural teeth.

58. • CROWN HEIGHT SPACE- should be between 8-12mm when not
in range-
1) shorten cantilever length
2 )Increase number and diameter of implant and splint them
3) Fabricate removable restoration that incorporate soft tissue
support Remove them at night
• BONE DENSITY- softer bone Increase number and diameter of
implant with more and deeper threads. As more stress over crest
so implant diameter is more significant then length.
• Minimum bone height for initial fixation & loading in
• D1=7mm, D2=9mm,D3=12mm, D4->12mmm

59. IMPLANT
POSITION
• Ideally occlusal force should be
directed through the long axis of
the implants.Therefore ,the
angle of the osseous ridge crest
is a key determinant of implant
angulation
• Maxilla anterior – 12 degree
• Mandible premolar - 10-15
degree
• Molar – 20-25 degree

60. SURGICAL
PROCEDURE
• Implant site evaluation:
• Minimum bucco –lingual
width– 7mm
• Mesio –distal 6.5mm
• Height – 11mm
• Soft tissue reflection – mid
crestal incision with a margin
of 1.5mm keratinized tissue
buccally extending to the sulcus
of adjacent teeth

61. • Implant osteotomy:
• Start with 2mm end cutting drill at the center of crest with 2500
rpm and copious irrrigtion upto 7-9mm
• Assess for proper position ,If incorrect position then side cutting
drill is used to stretch the osteotomy site.
• IOPA ensure the proper position with measuring tool
• Osteotomy proceeds with increasing size of twist drill bit shorter
than the size of desired implant
• Final implant position should clear the adjacent tooth and the
outer crestal cortical plate by 1.5mm.

62. • Implant placement:
• After final osteotomy, the site is lavaged and aspirated to
remove debris and blood
• The implant is rotated with 30 rpm (not more than 35 rpm) by
low speed high torque hand piece /hand ratchet
• The implant should inserted slightly above (one stage) or
below (Two stage). It should be rigid with no mobility on slight
compression

63. • Post insertion radiograph should be made to evaluate the
position , adjacent vital structure, crest module position.Any
correction can be made at this time. Low profile cover screw
is inserted into the implant body. Flaps most often
approximated with 4-0 suture material.
• If implant position is not within the ideal range, it may be
removed and reinserted.

64. IMPLANT
MAINTENANCE
• The principle is to detect peri implant
infections as early as possible
• The basis is a regular recall and repeated
assessment of the following key
parameters around each implant.
• Check the presence of-
 plaque
 bleeding tendency of the peri implant
tissue
 Suppuration
 Presence of peri implant pockets
 Radiological evidence of bone loss.

65. • If plaque and /or an increased tendency to bleed are detected
 implants are mechanically cleaned using a rubber cup and
polishing paste.
 Oral hygiene practices should be checked, and the proper plaque
control technique should be instructed and reinforced

66. • In the presence of pus or if first signs of peri-implant
tissue destruction are detected (pockets 4-5 mm &
slight bone loss)
 Oral hygiene practices combined with application of a
local antiseptic.
 The periimplant pockets are irrigated with 0.2%
Chlorhexidene and the patient is advised to rinse twice
daily with 0.12%Chlorhexidene.

67. • If pocket depth > 5mm, radiograph is taken.
If there is clear evidence of bone loss:
 then a microbiological sample is taken.
 If evidence of anaerobic flora found:
 Oral hygiene practices combined with application of a local
antiseptic & systemic antimicrobial therapy
• If the bone destruction is advanced:
 surgical intervention to correct the tissue morphology & GBR
techniques may be necessary

68. COMPLICATIONS • Inferior alveolar nerve injury
• Incision line opening
• Implant exposure: Partial/
complete
• Implant failure:
• Mobility of implant during healing
period
• Pain , infection
• Radiolucency around implant
whatever the cause, the implant
should be removed. Grafting and
reinsertion can be done after 8-
10wks.

69. CONCLUSION
• Dental implants have overall had high success rates, but their
placement and restoration still have the boundaries of both
biomedical science and art.
• The effectiveness of different designs of implant-supported
prostheses as well as associated treatment modalities,
prostheses retention and stability, leads to improvement in
speech, function and quality of life trials