Materials

1. Implant materials
PRESENTED BY:
DR. BHUPENDRA RIZAL
M.D.S 1ST YEAR
1

2. Contents
Introduction
History of implant materials
Advantages of implant
Classification of implant materials
Selecting an implant material
Summary and conclusion
References
2

3. Implants
Definition - is defined as insertion of any object or a material,
which is alloplastic in nature either partially or completely into
the body for therapeutic, experimental, diagnostic or prosthetic
purpose .
3

4. A dental implant is a material or device placed in and or on oral
tissues to support an oral prostheses.
4

5. A peep into history
5
2500 BC - Ancient
Egyptians - gold
ligature.
500 BC - Etruscan
population - gold bands
incorporating pontics.

6. 500 BC - Phoenician
population - gold wire.
300 BC - Phoenician
population - Carved
Ivory teeth.

7. 600 AD - Mayan
population - implantation
of pieces of shell.
1700 - John Hunter -
transplanting the teeth.

8. 1809 - Maggiolo -
pieces of gold.
1911 - Greenfield -
iridoplatinum basket
soldered with 24 carat
gold.

9. 1939 - Strock -
vitallium screw to
provide anchorage for
replacement.
1940 - Formiggini -
spiral implant -
stainless steel wire.

10. 1943 - Dahl -Subperiosteal
type of implant.
1948 - Goldberg and
Gershkoff - Extension of
frame work.

11. In 1952, Professor Per Ingvar Brånemark developed a threaded
implant design made of pure titanium.
Dr. Brånemark discovered that titanium apparently bonded
irreversibly to living bone tissue.
11

12. Early 1960s - Chercheve -
Double helical Spiral
implant of Cobalt
Chromium.
Early 1970s - Grenoble -
Vitreous Carbon implants.

13. Early 1980s - Tatum -
Titanium root form
implant
Late 1970s and Early
1980s - Tatum -
custom blade implants
of Titanium alloy

14. 1970 and 1980 - Weiss
and Judy - Titanium
Mushroom shaped
projection (IMPLANT)

15. After 1980s –hollow basket Core vent implant
Screw vent implant
Screw vent implant with Hydroxyapatite coating
implant with titanium plasma spray

16. Advantages of implant
 Bone maintenance
 Improved Facial esthetics, phonetic, occlusion, retention, stability
 Decreased size of prosthesis
 Elimination to alter adjacent teeth.
 Fixed prosthesis.
16

17. Materials used in the fabrication of the implant can be generally
classified into two different ways :
Chemical point – metals and ceramics
Biological point – biodynamic materials : bio-tolerant , bio-
inert, bioactive.
17

18. Bio-tolerant are those that are not necessarily rejected when
implanted into the living tissue.
• They are human bone morphogenetic protein-2( rh BMP-2 ) which
includes bone formation de nevo.
18

19. Bio-inert materials allow close approximation of bones in
their surface leading to contact osteogenesis.
• These materials allow formation of new bone in their surface and
ion exchange with the tissue leads to the formation of chemical
bonding along the interface bonding osteogenesis.
19

20. Bio-active are tissue integrated engineered materials design
to mimic specific biologic processes and help optimize the
healing/regenerative response of the host
microenvironment.
20

21. 21

22. Biological
biocompatibility
Chemical composition
Metals Ceramics Polymers
Biotolerant Gold Polyethylene
Cobalt-chromium
alloys
Polyamide
Stainless steel Polymethylmethacrylate
Zirconium Polytetrafluoroethylene
Niobium Polyurethane
Tantalum
Bioinert Commercially pure
titanium
Aluminum oxide
Titanium alloy (Ti-
6Al-4V)
Zirconium oxide
Bioactive Hydroxyapatite
Tricalcium
phosphate
Calcium
pyrophosphate
Fluorapatite
Carbon:vitreous,
pyrolytic
Bioglass

23. Factors affecting implant biomaterials
Mechanical
Chemical
Electrical and
Surface specific properties
23

24. Clinical success of dental implants
In 1979 Schintman and Schulman proposed following requirements –
 Mobility of an implant must be less than 1 mm .
 No evidence of translucency.
 Bone loss should be less than one third the height of the implants.
 There should be absence of infection, damage to structures, or violation of body
cavities.
 Success rate must be 75% or more after 5 yrs.' of functional service.
24

25. In 1986 Albrektsson et al included the following conditions-
 Individual ,unattached implant is immobile when tested clinically.
 Radiograph does not demonstrate any evidence of periapical translucency.
 Vertical bone should be less than 0.2mm following implants first year of service.
 Implant performance must be absent of signs and symptoms such as pain,
infections, neuropathies, paresthesia, or violation of mandibular canal.
 Success rate of 85% or more at end of 5 yrs.
25

26. Scope of implant in dentistry
1) Prosthetic rehabilitation of missing teeth
Complete edentulous maxilla and mandible rehabilitation.
Single tooth replacement
Partial dental loss replacement
Removable prosthesis
Fixed prosthesis

27. 2) Anchorage for the maxillofacial prosthesis
Auricular Prosthesis Ocular Prosthesis
Nasal prosthesis

28. 3) For rehabilitation of congenital and developmental defects
- Cleft palate
- Ectodermal dysplasia

29. 4) Complex maxillofacial defect rehabilitation
6) Orthodontic anchorage.
5) Distraction osteogenesis  new bone formation

30. Classification of implant
1. Based on implant design
2. Based on attachment mechanism
3. Based on macroscopic body design
4. Based on the surface of the implant
5. Based on the type of the material
30

31. I . Based on implant design:
 Endosteal implant
1. Ramus frame
2. Root form
3. Blade form
 Subperiosteal implant
 Transosteal implant
 Intramucosal implant
31

32.  An implant which is placed into the alveolar bone/basal bone of the mandible or maxilla
 Transect only one cortical plate
32

33. Subperiosteal implant
 Placed directly beneath the periosteum overlying the bony cortex
 Used to restore partially dentate or completely edentulous jaws
 Used when there is inadequate bone for endosseous implants.
 Limited use because of bone loss.
33

34. Transosteal implant
 Staple bone implant /Mandibular staple implant /Transmandibular
implant
 Combines the subperiosteal and endosteal components
 Penetrates both cortical plates
34

35. 35

36. Intramucosal implant
 Inserted into the oral mucosa
 Mucosa is used as attachment site for the metal inserts
 Disadvantages – painful healing, requirements for continual
wear
 No longer used.
36

37. 2. Based on attachment mechanism
 Osseo-integration
 Bio-integration
 Fibro-integration
37

38. Osseointegration:
• Direct contact between the bone and the
surface of the loaded implant
• Described by BRANEMARK
• Bio active material that stimulate the
formation of bone can also be used
38

39. “CONCEPT OF OSSEOINTEGRATION”
Dr. Per-Ingvar Branemark
Orthopaedic surgeon
Professor University of Goteburg, Sweden.
Threaded implant design made up of pure titanium.
Coined the term “osseointegration”

40.  “The apparent direct attachment or connection of osseous tissue to an
inert, alloplastic material without intervening connective tissue”.
- GPT 8
 American Academy of Implant Dentistry defined it as “contact
established without interposition of non bone tissue between
normal remodeled bone and on implant entailing a sustained
transfer and distribution of load from the implant to and
within bone tissue”.
40

41. DEVELOPMENT OF THE CONCEPT OF
OSSEOINTEGRATION
Based on research in 1952 – microscopic studies
carried out with vital microscopic technique in the bone
marrow of rabbit’s fibula.

42. Evidence for osseointegration
Macroscopic level
Histological level
Radiological level

43. Bio-integration:
• Some materials such as the bio-glass ceramics promote an
integration between bone and material with no intervening space.
When this integration occurs material is said to bio-integrate with the
bone.
• Bio-integration appears to require a degradation of bio-active
ceramic to promote bone formation.
• Some examples are Bio-glass, Ceravital, Bio-gran, Glass ceramic A-W
and β-wollastonite.
43

44. Fibro-integration:
• Proposed by Dr. Charles Wiess
• Complete encapsulation of the implant
with soft tissues
• Soft tissue interface could resemble the
highly vascular periodontal fibers of
natural dentition
44

45. 3. Based on body design
 Cylindrical
 Screw shaped
 Threaded
 Non threaded
45

46. Implant design can be broadly classified as root form implants
and blade form implants.
Root form implants cylindrical
screw shaped
Cylindrical Screw shaped implants
Non threaded Threaded

47. SCREW SHAPED IMPLANTS:
 bone grows into the threads providing
mechanical fixation (macro interlocking).
Advantages of screw shaped implants
 More functional area for load distribution than
the cylindrical implants.
 Threads improves the primary implant stability
avoids micromovement of the implants till
osseointegration is achieved.

48. CYLINDRICAL IMPLANTS :
Primary stability obtained by press-fit design and surface
roughness (micro interlocking)
Cylindrical implants show surface coatings to improve the
surface area.

49. 4.Based on implant surface
characteristic

50. Methods to alter surface texture are classified as:
• Additive surface treatment :
Titanium plasma spraying (TPS) ,
Hydroxyapatite (HA) coating
• Ablative surface treatment :
Grit blasting
Acid etching
Grit blasting followed by acid etching
• Modified surface treatment :
Oxidized surface treatment
Laser treatment
Ion implantation

51. • Turned surface/ machined surface
eg.-Branemark system (Nobel Biocare)
macroscopically smooth low surface roughness of
0.5 to 1um
Different machining process results in
different surface topographies
SEM x 1000 SEM x 4700

52.  ACID ETCH SURFACE - in solution of HCl and H2SO4
eg., Osseotite implant system (Implant Innovations)
 BLASTED SURFACE – TiO2 / Al2O3 particles

53. Sand blasted (large grit) and acid-etch surface
(SLA surface)
 Sandblasting – 250-500um corundum grit -
macroroughness
 Acid etching –hot solution of HCL and H2SO4 -
microroughness and cleans the implanT surface.
Ledermann screw Ha-Ti implant system

54. Titanium plasma sprayed coating (TPS)
This tech involves forcing noble gas, which is split into ions and
electrons through an intensely burning arc (15000-20000 deg C) at a
very high speed (3000m/s).the coating material (Ti hydride) is fed into
the hot gas spray using argon. The hydride decomposes into in the
stream of hot gas and small droplets of metal are shot onto implant
surface.

55. • 6-10 times increase surface area. Steinemann 1988,
Tetsch 1991
• Surface roughness – 6um
IMZ Implant system ITI bonefit Implant system

56. Hydroxyapatite coated surface
HA coated implant - bioactive
surface structure
Indication
 Greater bone to implant
contact area required
 Type IV bone
 Fresh extraction sites
 Newly grafted sites
SEM 100X

57. Laser induced surface roughening
“Excimer laser” used to create roughness on implant
surface.
Laser can be precisely targeted resulting in creation of
regularly oriented micro retention compared to TPS
coating and sandblasting
SEM x 3000
SEM x 300
SEM x 70

58. 5. Based on implant materials
 Metallic implant
 Ceramic and ceramic coated
 Polymer and
 Carbon compound
58

59. 1. Metallic implant:
 Dental implants are constructed using metals and alloys. These include
titanium, tantalum, and alloys of aluminum, vanadium, cobalt, chromium,
molybdenum and nickel.
 Most popular material in use today
is TITANIUM
 Other metallic implants are stainless
steel cobalt chromium
molybdenum alloy, vitallium
59

60. Titanium
 Discovered in 1789 by Wilhelm Gregor.
 Represents only 6% of the earth crust.
 Industrial use started 60 years ago with use in aerospace and defense
because of it's light weight, high strength and high melting point.
 Used as biomaterials in dental implants , orthopedic and cardiovascular
applications.
 Excellent biocompatibility, corrosion resistance, and desirable physical
and mechanical properties.
60

61. General properties of titanium
• Atomic number – 22
• Atomic wt – 47.9
• Melting point is 1680 degree
• High tensile strength
• Highly rigidity due to high modulus
of elasticity
• Low weight
• High corrosion resistance
61

62. American society for testing materials (ASTM) classified titanium into
grades; which vary according to oxygen(0.18-0.40 wt%) iron (0.20-0.50
wt%) and other impurities which includes nitrogen, carbon and
 Grade I is the purest and softest form , and have moderately high
tensile strength.
 As the grade goes up, the stronger the titanium becomes
 Grade V contains aluminum and vanadium along with titanium,
making it stronger than grades I-IV
62

63. Advantages
 Strong
 Lightweight
 Corrosion Resistant
 Cost-efficient
 Biocompatible (non-toxic AND not rejected by the body)
 Long-lasting
 Non-ferromagnetic
 Osseo-integrated (the joining of bone with artificial implant)
 Long range availability
 Flexibility and elasticity rivals that of human bone
63

64. Dental Titanium
 Titanium has the ability to fuse together with living bone. This property makes it
huge benefit in the world of dentistry.
 Titanium dental implants have become the most widely accepted and
successfully used type of implant due to its propensity to Osseo-integrate.
 When bone forming cells attach themselves to the titanium implant, a structural
and functional bridge forms between the body’s bone and the newly
foreign object.
 Alfa-bio, Bredent, Nobel Bio-care are the most widely used dental implants.
64

65. COBALT-CHROMIUM MOLYBDENUM ALLOYS:
 Elemental composition of this alloy consists of-
 Cobalt- 63%
 Chromium- 30%
 Molybdenum- 5%
 Carbon , manganese and nickel- traces.
65

66.  COBALT: provides continuous phase of the alloy
 CHROMIUM: provides corrosion resistance through the oxide
surface(Cr2O3).
 MOLYBDENUM : stabilizer; also provides strength and bulk corrosion
resistance.
 CARBON: serves as a hardener
 Secondary phases based on Co, Cr, Mo, Ni and C provides strength(4
times that of compact bone) and surface abrasion resistance.
66

67.  ADVANTAGES :
 Low cost and ease of fabrication
 When properly fabricated , good biocompatibility
 DISADVANTAGES :
 Poor ductility
 VITALLIUM was introduced by Venable in 1930’s and is part of Co-Cr –Mo alloy family.
67

68. Stainless steel
 18 % chromium for corrosion resistance.
 8 % nickel to stabilize the austenitic structure.
 80% iron
 0.05-0.15% carbon
Properties:
 It has high strength and ductility, hence is resistant to brittle fracture.
 High Tensile strength
 Ease of fabrication
 It cannot be used in Ni sensitive patients
 Susceptible to pit and crevice corrosion
 Galvanic potential.
68

69. 2. Ceramic implant
69

70. GENERAL PROPERTIES OF CERAMICS:
 High compressive strength upto 500MPa.
 Less resistance to shear and tensile stress
 High modulus of elasticity
 Brittle, can withstand only relatively low tensile
stresses.
 Tolerate high levels of compressive stresses.
 ceramic materials are not bio-active.
 Have high strength, stiffness and hardness
function well as subperiosteal or trans-osteal
implants.
70

71. Bio-inert
71

72.  Use of calcium phosphates as coating materials for metallic implants promotes bone to
implant integration.
 The more HA coating the more resistant it is to clinical dissolution.
 A minimum of 50% crystalline HA is considered an optimal concentration in coating of
implants.
 Dissolution of the ceramic coating occurs at a higher rate with a more amorphous HA
structure.
 Advantage of ceramic coating is that they stimulate the adaptation of bone.
 Studies suggest that there is greater bone – to – implant integration with the HA coated
implants.
72
Bio-resorbable

73.  Another form of bioactive ceramics are bio-glasses.
 Known to form a carbonated hydroxyapatite layer.
 Formation of layer is initiated by migration of calcium, phosphate,
silica and sodium ions towards tissue . Silica gel layer is formed.
 Silicon depletion initiates migration of calcium and phosphate
ions
 Calcium-phosphorous layer is formed that stimulates osteoblasts
to proliferate, stimulating the formation of bone.
 Bio-glasses are very brittle, which makes them unsuitable for use
as stress bearing implant
73
Bio-active

74. Advantages
 Porous, strong and non-brittle composition
 Rapid fibro vascularization
 No risk of disease-transmission
 Lightweight and easy to insert during surgery
 Easy to suture to extra ocular muscles
 Effortlessly hand-drilled without crumbling
 Non-dissolving
 Does not release soluble components
 Does not cause excessive tissue inflammation
74

75. 3. Polymeric implants
 Polymeric implants -First used in 1930,s.
 Not used nowadays :-
• Because of low mechanical strength and susceptibility to fracture during function.
• Sterilization accomplished only by gamma radiation or exposure to ethylene
oxide gas .
• Contamination of polymers.
• During 1940s methyl methacrylate was used for temporary acrylic implants to
preserve dissected space to receive a Co-Cr implant later.
75

76. General properties
 Low mechanical strength hence susceptible to mechanical fracture
 Physical properties of polymers are greatly influenced by changes in temperature,
environment and composition.
 Their sterilization can be accomplished only by gamma irradiation of exposure to
ethylene oxide gas.
 Contamination of these polymers because of electrostatic charges that attract dust
and other impurities from the environment.
76

77. PEEK
 A type of Specialty Polymer; belongs to polyaryl ether ketone family
 Is a colorless thermoplastic
 Semi-crystalline
 Has ether (-O-) as well as ketone (-CO-) linkages
 Formed by step-growth polymerization
 Has excellent mechanical properties
77

78. Applications
 Used in medical implants
 Fabrication of bearings, pistons, pumps, HPLC, compressor plate valves &
cable insulation
 Used for ultra high vacuum applications
 Coatings for metals
 Applications in aerospace, automotive & chemical processing industries
 Used in spinal fusion devices
 Used as reinforcing rods
78

79. PEEK as Metal/Steel replacement
 PEEK is much lighter in wt
 Has comparable strength
 Resistant to chemicals at room temp
 Resistance to corrosion
 Is weldable, machinable
 Can be bonded with epoxies
79

80. 4. Carbon implants
 Carbon and its compounds were introduced in the 1960’s for use in implantology.
 VITREOUS CARBON, which elicits a very minimal response from the host tissues, is
one of the most biocompatible material
80

81. Advantages
 Carbon is inert under physiological conditions.
 Has a modulus of elasticity equivalent to that of dentin and bone.
 Thus it deforms at the same rate as these tissues enabling adequate
stress distribution.
81

82. Disadvantage
 Because of its brittleness, carbon is susceptible to
fracture under tensile stress, which is usually generated
as a component of flexural stress.
 It also has a relatively low compressive strength.
 Thus a large surface area and geometry are required to
resist fracture.
82

83. Selecting an implant material
 Important consideration is the strength of implant material and type of bone in
which implant is placed.
 For high load zone eg in posterior areas high strength material such as CP grade IV
titanium or titanium alloys are used.
 Anterior implants designated for use in narrow spaces have smaller diameters in
range of 3.25mm.
 Single implants placed in posterior areas have large diameters up to 5.0 mm
83

84. According to type of bone:
 Type I- consists of homogenous compact bone.
 Type II- consists of thick layer of compact bone surrounding a core of dense trabecular bone.
 Type III- is a thin layer of cortical bone surrounding a core of dense trabecular bone.
 Type IV- is composed of thin layer of cortical bone with a core of low-density trabecular bone
84

86.  Much debate about when to use metal implants or ceramic coated implants.
 HA coated implants stimulate bone growth.
 Some studies show that HA is a very unstable implant material.
 Gottlander and Albrektsson examined bone to implant contact area both at 6 weeks
and 12 months for HA and CPTi coated implants.
 They concluded that bone – implant contact at 6 weeks was 65% for HA and 59% for
Ti.
 However at 12 months Ti exhibited 75% contact area versus 53% for HA.
86

87. Ailing implants are those showing radiographic bone
loss without inflammatory signs or mobility.
Failing implants are characterized by progressive
bone loss, signs of inflammation, and no mobility.
These implants are usually in a reversible state (ie., the
condition can be treated).
Failed implants are those with progressive bone loss
with clinical mobility and that are not functioning in
the intended sense.

88. AILING IMPLANTS
 It is least seriously affected of the three
pathologic states.
 Exhibits soft tissue problems (Peri-implant
mucositis.
 Have a favourable prognosis.
88

89. FAILING IMPLANTS
 Shows evidence of
- Pocketing
- Bleeding upon probing
- Purulence
- Progressive bone loss
 Have a poorer prognosis when compared with Ailing
Implants
 If properly treated, a failing implant may be saved.
89

90. FAILED IMPLANTS
 Horizontal mobility beyond 0.5mm
 Rapid progressive bone loss
 Pain during percussion or function
 Continued uncontrolled exudate
 Generalized radiolucency around an implant
 More than one half of the surrounding bone lost
around an implant
 Implant inserted in poor position making them
useless for prosthetic support.
90

91. Summary and conclusion
Dental implantogy is an exciting treatment concept that includes a series of
surgical, prosthetic and periodontal restorative skills. Implant systems currently
available are diverse. Implant materials range from commercially pure titanium
to HA coated devices. When the mechanisms that ensure implant bio-
acceptance and structural stabilization are fully understood, implant failures will
become a rare occurrence provided they are used properly and placed in sites
for which they are indicated with proper sterilization and care.
Dental implantology will be highly accepted and predictable treatment modality
for the restoration of human dental and oral apparatus.
91

92. References
Upshaw J.E Dental implants Anusavice, Phillip’s Science of Dental Materials, 11th edition, Saunders publications.
O’Brien.W.J, Dental materials and their selection, 3rd edition, Quintessence publications.
Craig.R.G, Restorative Dental Materials, 12th edition, Elsevier publications.
McCracken M. Dental Implant Materials: Commercially pure titanium and titanium alloys. JPD 1999:8:1:40-43.
Carl .E. Misch Contemporary Implant Dentistry 3rd edition
Dental Implant Prosthetics 2nd Edition By Carl E. Misch
Manual of Dental Implants by David P. Sarment
92

93. 93