This document discusses dental implants and their use in dentistry. It defines what an implant is, describes the different parts and types of implants. It also outlines the implant placement procedure and discusses factors to consider for pre-surgical planning like medical/oral contraindications and patient selection. Complications of sinus lift procedures are mentioned. The document emphasizes the importance of osseointegration between implants and bone. Finally, it briefly introduces the prosthetic phase including different types of abutments and restorative solutions like cement-retained and screw-retained restorations.

1. IMPLANTOLOGY
 Dr V.RAMKUMAR
 CONSULTANT DENTAL&FACIOMAXILLARY
SURGEON
 REG NO: 4118-TAMILNADU-INDIA(ASIA)

2. What is implant?
A dental implant is an artificial root that replaces
the natural tooth root.
Crown
Gum
Implant
Tooth Root
Jawbone

3. Parts of implant
Cover screw
Implant abutment interface
Implant collar
Fixture

4. Tooth loss leads to bone loss - Anterior
The more teeth
that are lost, the
greater the
impact to your
patient’s
appearance and
psychological
well-being.
Why Dental Implants?

5. Why Dental Implants?
Tooth loss leads to bone loss - Posterior
The average reduction in
ridge height in the
mandible during the first
year after extraction is
4mm to 5mm.
Note: Wear from clasp on an otherwise
healthy adjacent tooth

6. CLINICAL OPTIONS
preserve those two
healthy teeth...
Place a single implant and
provide a restoration that
looks, feels and functions
like a natural tooth

7. Single-Tooth Implant: Advantages
 High success rates (better than 97% for 10 years).
 Decreased risk of caries of adjacent teeth.
 Decreased risk of endodontic problems on adjacent
teeth.
 Improved hygiene.
 Decreased cold or contact sensitivity of adjacent
teeth.
 Psychological advantage.
 Decreased abutment tooth loss.

8. Consequences of Bone Loss in
Fully Edentulous Patient
 Decreased height & width of supporting bone.
 Prominent mylohyoid and internal oblique ridges. With
increased sore spots.
 Progressive decrease in keratinized mucosa surface.
 Prominent superior genial tubercles, sore spots, and
increased denture movement.
 Muscle attachment near crest of ridge.
 Elevation of prosthesis with contraction of mylohyoid and
buccinator muscles serving as posterior support.
 Thinning of mucosa, with sensitivity to abrasion.

9. Contd..
 Forward movement of prosthesis from anatomical inclination
(angulation of mandible with moderate to advanced bone lass).
 Loss of basal bone.
 Paresthesia from dehiscent mandibular neurovascular canal.
 More active role of tongue in mastication.
 Effect of bone loss on esthetic appearance of lower one third of
face.
 Increased risk of mandibular body fracture from advanced bone
loss.
 Increased denture movement and sore spots during function
caused by loss of anterior ridge and nasal spine.

10. Soft Tissue Consequences of
Edentulism
 Attached, keratinized gingiva is lost as bone is lost.
 Unattached mucosa for denture support causes
increased soft spots.
 Thickness of tissue decreases with age, and systemic
disease causes more sore spots for dentures.
 Tongue increases in size, which decreases denture
stability.
 Tongue is more active in mastication, which decreases
denture stability.
 Neuromuscular control of jaw decreases in the elderly.

11. Esthetic Consequences of Bone
Loss
 Decreased facial height.
 Loss of labiomental angle.
 Deepening of vertical lines in lip and face
 Rotation of chin forward, giving a prognathic appearance.
 Decreased horizontal labial angle of lip, making patient look
unhappy.
 Loss of tone on muscles of facial expression.
 Thinning of vermillion border of the lips from less of muscle tone.
 Deepening of nasolabial groove.
 Increase in columella-philtrum angle
 Increased length of maxillary lip so that fewer teeth show at rest
and smiling, which ages the smile.

12. Decreased Performance of
Removable Prostheses
 Bite force decreased from 200 psi to 50 psi.
 Bite forces of 15-year denture wearers reduced to 6
psi.
 Masticatory efficiency decreased.
 Increased drug use for gastrointestinal disorders.
 Possible decrease in life span.

13. Consequences of Removable
Partial Dentures
 Survival rate 60% at 4 years.
 Survival rate 35% at 10 years.
 Repair of abutment teeth.
 Increased mobility, plaque, bleeding on probing, and
caries of abutment teeth.
 Abutment tooth loss of 44% within 10 years.
 Accelerated bone loss in edentulous region if one
wears a removable partial denture.

14. Psychological Effects of Tooth
Loss
 Psychological effects range from minimal to
neuroticism.
 88% of patients claim some difficulty with speech,
and 25% have significant problems.

15. Advantages of Implant-supported
Prostheses
 Bone maintenance.
 Restoration and maintenance of Occlusal vertical
dimension.
 Maintenance of facial esthetics (muscle tone).
 Esthetic improvement (teeth positioned for appearance
versus decreasing denture movement).
 Improved phonetics.
 Improved occlusion.
 Improvement or allowance for regaining of oral
proprioception (Occlusal awareness).
 Increased prosthesis success.

16. Contd..
 Improved masticatory performances and
maintenance of muscles of mastication and facial
expression.
 Reduced size of prostheses (eliminate palate and
flanges).
 Provision for fixed versus removable prostheses.
 Improved stability and retention of removable
prostheses.
 Elimination of need to alter adjacent teeth.
 More permanent replacement.
 Improved psychological health.

17. Dental implants
preserve bone and …
…healthy vital tooth
structure.
Implants are the
conservative option.

18. 1. Endosseous or root-form Implants
 Screw or Thread type Implants
 Cylindric or Press fit type Implants
 Tapered Implants
2. Blade form Implants
3. Subperiosteal Implants
4. Transosseous Implants
 Mandibular staple Implant
 Transmandibulor Implants or Bosker Implant

19. Blade form Implants
Blade Implants are rectangular and are similar in
shape to a razor-blade.
The rectangular part of the Implant is placed
into the bone via a Linear Osteotomy and the posts
extend above the gingiva.

20. Subperiosteal Implants
 These are metallic meshes that are custom-built to
fit over the alveolar process and under the
periosteum.
 Several metal posts extend from the mesh into the
oral cavity above the gingiva to support the
prosthesis.

21. Cont..
This procedure involves two surgical visits:
 In the first visit, the alveolar process is surgically
exposed and an impression is obtained to fabricate
the implant.
 Implant is fabricated in the laboratory,
 In the second visit, placement of the implant is done.

22. Transosseous Implants
1…Mandibular staple Implant:
implant was indicated for patient with moderately
resorbed mandibles but with at least 9 mm of
vertical bone height present between the mental
foramina.

23. 2…Transmandibulor Implants or Bosker
Implant:
This form of implant allows construction of a
functional prosthesis without augmenting the
mandibular body with bone and without stimulating
further resorption or injury to the nerve.

24. Indications for TMI system
 Severe mandibular atrophy.
 Type IV bone quality.
 Osteoporosis.
 Factures of an atrophic mandible.
 Parafunctional habits.
 Following radiation therapy.
 Mandibular resection and reconstruction.
 Removal of endosseous, subperiosteal and
transosseous Implants.

25. Endosseous or root-form Implants
1. Screw or Thread type Implants:
 Uses threads for primary
stabilization.
 For the placement of the Threaded
Implant the osteotomy site is tapped
or prethreaded with a thread-former
bur, to create the threads in the wall
of the osteotomy site.

26. 2. Cylindric or Press fit type
Implants:
 Uses friction for primary
stabilization.
 The placement of a Cylindric
Implant depends on the friction
between the Implant surface and the
bone.
Thus no tapping is required.

27. 3. Tapered Implants:
 Resemble a tooth root.
 design for both Threaded and Press
fit type Implant.
 Initially design for immediate
placement into extraction socket.

28. PPrree--SSuurrggiiccaall PPllaannnniinngg
 Organized pre-surgical team planning is key
to the success of an implant restoration.
important considerations:
 Implant placement
 Occlusal design
 Hygiene maintenance
need to be discussed.

29. Medical Contraindications
Absolute Contraindications
 Recent myocardial infarction
 Valvular prosthesis
 Severe renal disorder
 Uncontrolled diabetes
 Uncontrolled hypertension
 Generalized osteoporosis
 Chronic severe alcoholism
 Radiotherapy in progress
 Heavy smoking(20 cig. a day)

30. RELATIVE CONTRA INDICATIONS
 Cardiovascular problems
 Congestive heart failure
 Coronary artery disease
 Prosthetic heart valves
 Rheumatic heart disease
 Endocrine disorders (e.g., calcium, iron, avitaminosis, low
estrogen in females)
 Hyperactive involuntary muscle movements (e.g., Parkinson’s,
Huntington’s)
 Bone disorders (e.g., osteomyelitis, osteopetrosis, osteoporosis)
 Benign/malignant bone neoplasms or cysts and fibro-osseous
disease
 pregnancy

31. 3…Precautions should also be used in
patients with histories of:
 Blood dyscrasia (e.g.; anemia, sickle cell,
polycythemia vera and purpura, granulocytopenia)
 Pulmonary problems (e.g., asthma, bronchitis,
emphysema)
 Mental therapy
 Psychiatric or psychological disorders
 Mental retardation
 Chemotherapy
 Irradiation (5,000 rads or greater)
 Hemophilia

32. Oral Contraindications:
 Ridge dimensions are insufficient to accommodate
proper implant placement
 Lateral oral interferences are present
 Habits such as-
 Tobacco use
 Alcohol consumption
 Poor orel hygiene
 Bruxism
 Nail biting
 Pencil biting
 Tongue habits

33. Before Placement Of an Implant
 Survey the surgical site clinically and
radiographically
to evaluate
1. Any residual infection is present in the bone
2. Presence of a periapical lesion in adjacent
teeth

34.  Any active endodontic lesions adjacent to the
implant site should be treated before endosseous
implant placement.

35.  Any active endodontic lesions adjacent to the
implant site should be treated before
endosseous implant placement.
Overhanging restoration /
localized periodontal diseases periostits

36. PPaattiieenntt sseelleeccttiioonn
Presentation of Patient:
 Mental Status (alertness, coherence,
comprehension)
 Gait (manner, abnormalities)
 Overall appearance (neatness, cleanliness)
 Sign of tobacco and alcohol abuse

37. Patient’s Attitudes:
 Chief complaints
 Concept of own dental function and appearance
 Expectations
 Desired results
 Oral hygiene
 Esthetic expectations
 Desired functional results

38. Patient’s dental history:
 Condition of soft tissue
 Condition of teeth
 Edentulous areas
 Current prosthesis and ability to provide esthetics,
phonetis, and function
 Temporomandibular joint problems

39. Proper blood screening and laboratory
evaluation
 Platelet count
 PTT
 PT
 urinalysis

40. Diagnostic aids
 Panoramic Radiographs
 Lateral Cephalograms
 Tomograms and CT scans
 Mounted Study Cast and Diagnostic Wax-up

41. Surgical guide/Template
The most important aim of a surgical guide is to
guide the surgeon where to place the implant
optimally. In addition, the surgical guide provides
information about the tooth and supporting
structures that have been lost.
A well-designed surgical guide provides visual
communication between the restorative dentist,
implant surgeon and dental laboratory technician.

42. Implant Selection

43. Influence of implant diameter and length
on crestal stress distribution
 1). Greater the diameter of the dental
implant less the crestal bone stress.
 2). Greater the length of the implant less
the crestal bone stress.

44. Implant Placement Procedure
4 Screw Tap 5 Implant
placement
2 Tapered Drill
ø 3.5 mm
3 Tapered Drill
ø 4.3 mm
1 Twist Drill
ø 2.0 mm

45. •Make an incision for elevation of a flap
•Drill to the appropriate depth
•Check orientation of the preparation site using
direction indicator

46. • Drill to the desired depth to enlarge the implant site
•Check orientation of the prepared site using direction indicator

47. • Drill to the desired depth to enlarge the implant site
• Implant placement with implant driver Select RP

48. • Use the Surgical Torque Wrench to rotate the implant
• Use the screwdriver to pick up the Cover screw and
thread it into the implant
• Close and suture the tissue flap

50. Direct sinus lift

51. Complications
 Membrane perforation.
 Presence of bony septae which divide sinus into
separate compartments.
 Postoperative infection.
 Wound dehiscence.
 Barrier Membrane exposure.
 Transient sinusitis.

52.  The word osseointegration was defined as “a direct
structural and functional connection between
ordered, living bone and the surface of a load
carrying implant.”
 Bone healing around implants results in a well-defined
progression of tissue responses that are
designed to remove tissue debris, to reestablish
vascular supply and produce a new skeletal matrix.

53. Prosthetic phase

54. Abutments
Abutments are simply transmucosal extensions
for the attachment of prostheses. Abutments can be
used to provide a restorative connection above soft
tissues and to provide for the biologic width.
Abutments can be used for attachment of screw-retained
or cemented connections and can be made
of metal or ceramic. The most commonly used
abutment material is machined titanium, which has
been shown to be strong and resistant to plaque
retention, and to react favorably to soft tissues.

55. Healing abutment/Gingival former

56. Esthetic abutment

57. Angled Esthetic Abutment

58. Multiunit abutment

59. Ball abutment

60. Bar supported over denture

61. Restorative solutions are the Goal
With the internal connection, three broad
categories of restorations are possible:
 Cement-retained restorations
 Screw-retained restorations
 Overdenture restoration

62. Treatment Alternative
 One-stage Immediate Function:
 One-stage Delayed Function
 Two-stage Delayed Function

63. One-stage Immediate Function
Procedure overview
restoring teeth with the implants and Immediate
Function is similar to crown & bridge.
Requirements for Immediate Function
 High initial implant stability
 Controlled loads
 Osseoconductive implant surfaces

64. One-stage Delayed Function
The one-stage surgical procedure does not
require a second surgical stage, abutments
are left protruding through the soft tissue.

65. Two-stage Delayed Function
The two-stage surgical procedure protects
dental implants from functional loading by
submerging the implants below the mucosa
at the time of placement.
This requires a second surgical stage to
uncover the implant.

66. 1 Abutment connection 2 Impression abutment level
3 Laboratory procedures 4 Final restoration

67. Maintenance phase
 The importance of the maintenance
procedures should never be
underestimated by either the patient or
the therapist.

68. Implant Hygiene Products
 Soft bristle toothbrush
 Non-abrasive toothpaste
 Proxy brush
 Dental floss
 Electric toothbrushes
 End-tuft brush
 Antimicrobial rinses
 Plastic scalers

69. Implant Hygiene Products

70. WWhhyy tthhee iimmppllaannttss ffaaiill…….. ??

71. CCllaassssiiffiiccaattiioonn
 Surgical Complications:
Inoperative Complications
1….Oversize Osteotomy.
2….Perforation of cortical plates.
3….Inadequate soft tissue flaps for
Implant coverage.
4….Broken burs.
5….Improper Instrumentation
6….Hemorrhage.
7….Poor angulations & Position of Implant.

72.  PROSTHETIC COMPLICATIONS:
Component & framework breakage
1….Fractured Frameworks & Mesostructure bars
2….Partial loosening of cemented bars and prostheses
3….Inaccurate fit of castings
4….Inadequate Torque application
5….In accurate frame work abutment interface
6….Occlusal factors
7….Implant Fracture
8….Implant loss

73.  Short term complications:
(
1… Postoperative infection.
2… Dysesthesia.
3… Dehiscent Implants.
4… Radiolucencies.
5… Antral complications.
6… Implant mobility.

74.  LONG TERM COMPLICATIONS
1…Ailing Implants.
2…Failing implants.
3…Failed implants.

75. The factors for long term complication could be:
1--- Nutrition
2--- Age related factors
3--- Factors secondary to systemic diseases
4--- Bruxism
5--- Traumatic Occlusion.
6--- Improperly designed superstructures.
7--- Unacceptable oral hygiene.
8--- A physiologically incompetent implant design.

76. Ailing Implant
 The ailing implant is the least seriously affected
Implants.
 Nothing more than a radiographic evidence of
diminishing but static bone loss may direct the
implantologist to be suspicious.

77. Failing Implant
 The failing implants are firm. Osseointegration
develops apically and is responsible for the implants
stability. Routine radiography reveals progressive
bone loss around the cervical areas of the implant.
BONE RESORPTION……..

78.  Failing implants
 Actinobacillus actinomycetemcomitans
 Porphyromonas gingivalis
 Prevotella intermedia

79. Failed Implant
 The simplest definition of a failed implant is
mobility. This can be diagnosed by:
1… Tapping and receiving a dull sound.
2… Manipulating by two mirror handles and
detecting movement.
3… By the use of the Periotest and eliciting
a response of +9 or higher.

80. Keys to Success
 1) Take in consideration maintenance
liability and health of bone.
 2) Give consideration to angiogenesis and
blood supply.
 3) Do plan the final prosthesis before
starting the case.

81. TEN COMMANDEMENTS OF
OSSEOINTEGRATION (Henry P.)
 1.Thoug shall not violate biocompatibility
 2.Thougshall not compromise implant design
 3.Though shall respect implant surface microstructure
 4 .Thou shalt address the status of the implant bed
 5.Thou shalt utilizeatraumatic surgical techniques
 6.Thou shalt formulate optimal loading conditions
 7. Thou shalt create acceptable soft tissue interface and esthetic
harmony
 8. Thou shalt monitor and maintain all restorations
 9.Thou shalt love thy neigbour as thyself
 10.thou shalt not bear false witness

82.  Penny wise – pound foolish
 Daily floss your implant tooth

83.  THANK -U