The document provides an introduction to dental implants, discussing why they are used to maintain bone volume, preserve adjacent teeth, and provide a natural emergence profile. It describes the different types of implants including root form, blade, and ramus frame implants and explains the process of osseointegration. The document also covers implant abutment connections, surface treatments, and relative and absolute contraindications for dental implants.

1. INTRODUCTION TO CONTEMPORARY
DENTAL IMPLANTOLOGY
Dr. Mohamed A. Fouda BDS, MSc
Cairo University
Periodontist

2. Prosthetic Options in Dentistry

9. Why Dental Implants?

10. • It Maintains Bone Volume.

11. • Bone needs stimulation to maintain its form and
density.
• Loss of teeth leads to loss of width then height of the
bone.
• After one year 25% of width and up to 4 mm of
height will be lost.
TODAY THE PROFESSION MUST CONSIDER NOT ONLY
THE LOSS OF TEETH BUT ALSO THE LOSS OF BONE.

12. • It Maintains Bone Volume.
• Preservation Of Adjacent teeth.
• Natural Emergence Profile.
• Increases stability and Retention.
• Reduce Removable prosthesis size.

13. What is a dental implant ?
• A dental implant is an artificial tooth root
replacement and is used in prosthetic
dentistry to support restorations that
resemble a tooth or group of teeth.

14. Sub-periosteal Implants

17. Trans-mandibular implants

19. Ramus frame Implant

21. Mucosal inserts

23. Blade implants

28. Root Form Implants

29. Osseointegration
Osseointegration is defined as “a
direct structural and functional
connection between the ordered
living bone and the surface of the
load carrying implant”
(Branemark, 1983).
Bone has been shown to be
approximately 20 nm away from
the implant surface when
examined with the electron
microscope (Albrektsson, 1985).

30. Branemark

31. The Edentulous Alveolar Ridge
• The formation and the continued preservation
of alveolar ridge is dependant on the
continued presence of teeth.
• Also the shape of teeth is an important factor
in determining the shape of the alveolar
process.

32. Thick tissue biotype  subjects have
short and wide teeth
Thin tissue biotype  subjects have
long and narrow teeth

33. Effect of tooth loss on the alveolar
ridge

34. Bone loss is more pronounced on the buccal aspect than the
lingual/palatal aspect of the ridge

35. CLASSIFICATION OF REMAINING BONE
A& B  Substantial amount of alveolar bone remains
C, D & E  Minute amount of alveolar process remains
Lekhom and Zarb (1985)

36. CLASSIFICATION OF BONE DENSITY
CARL MISCH

37. Topography of the alveolar process

40. MACRO DESIGN
IMPLANT MATERIALS
Commercially Pure Ti Ti Alloy Zirconia
Titanium 6AL-4V

41. • Titanium implants are biocompatible due to the formation of
an oxide layer on their surface which is resistant to corrosion
and have hydrophilic properties (Hansson et al 1983), When
exposed to air, Titanium forms an oxide layer immediately that
reaches a thickness of 2 to 10 nm by 1 sec and provides
corrosion resistance (Ducheyne 1988; Donley and Gillette
1991).
• Because of the high passivity, controlled thickness, rapid
formation, ability to repair itself instantaneously if damaged,
resistance to chemical attack, catalytic activity for a number of
chemical reactions and modulus of elasticity compatible with
that of bone of titanium oxide, Titanium is the material of
choice for intraosseous applications (Parr et al 1985; Kasemo
and Lausmaa 1985).

42. TWO-PIECE Vs. ONE-PIECE

43. MINI IMPLANTS

45. CYLINDRICAL Vs. TAPERED

46. • The original endosseous implants were
cylindrical (parallel) in design, although this
design was proven to be successful, it was not
suitable for all applications. One of the most
obvious limitations of its use is narrow ridges
and ridges with concavities as there is an
increased risk of perforation in the labial bone
(Garber et al 2001).

47. • The introduction of tapered implants resulted
in improved esthetics and easier placement
between the adjacent natural teeth as it
resembles more closely the shape and taper
of the original teeth roots (Shapoff 2002) ,
also it has the ability to accommodate the
shape of thin ridges and ridges with labial
concavities more than cylindrical implants
(Garber et al 2001).

48. • The theory behind the use of tapered implants
is to provide for a degree of compression of
the cortical bone in a poor implant site,
tapered implants distribute forces into the
surrounding bone, thereby creating a more
uniform compaction of bone in adjacent
osteotomy walls compared with parallel
walled implants. Thus when inserted, it
creates lateral compression of bone
(O’sullivan et al 2004).

49. TYPES OF IMPLANT-ABUTMENT
CONNECTIONS

50. External Hex

51. Internal Hex

53. Internal Taper

54. Morse Taper
Morse taper refers to a taper of
5/8ths of an inch per foot

55. Spline

56. Cover Screw

57. Implants Threads
• Threads are added to the implant body and
are used to:
1. maximize initial contact between the
implant and bone
2. To improve initial stability
3. To enlarge implant surface area
4. To favor dissipation of interfacial stress.

61. MICRO ANATOMY

62. • The original studies on osseointegration were
performed using turned (machined) surface
implants. Efforts to enhance implant surface
technology have focused on improving the
predictability, rate, and degree of
osseointegration.
• Until now, there is no consensus concerning
the most appropriate implant surface
topography (Raghavendra et al 2005).

63. • Some important advantages have been
attributed to increased surface roughness.
These include increased surface area of the
implant adjacent to bone, improved cell
attachment to the implant surface, increased
bone present at the implant surface, and
increased biomechanical interaction of the
implant with bone (Cooper 2000).

64. SURFACE TREATMENT
Addition:
1- HA Coated
2- TPS

65. SURFACE TREATMENT
Subtraction:
1- Acid etching
2- Acid etching and
Grit blasting

66. •Edentulous ridge (Branemark 1952)  60 years of
research
•Single tooth replacement  41 years of research
•Immediate tooth replacement  34 years of research

67. RELATIVE CONTRAINDICATIONS
•Age
•Patient’s general health
•Smoking
•Patient psychology and motivation
•Availability

68. ABSOLUTE CONTRAINDICATIONS
•Drug or Alcohol abuse
•Psychological
•Debilitating or uncontrolled disease

69. PERIODONTAL THERAPY VS. IMPLANT
THERAPY
The 0, 5, 10 years rule
•Included in treatment
•Extraction and site
plan
development
•Can be joined to
implants
•Independent implant restoration.
• If adjacent to an edentulous site consider reducing
the prognosis

70. EXAMPLES
•Smokers  moderate and sever Periodontitis  extraction and
dental implant placement (implant is in direct contact with bone
less effect from smoking)
•Unsuccessful treatment with progressive bone loss  When
remaining bone is 10 mm  extraction (minimum predictable
implant length 10 mm).
•Grade III Furcation involvement  Implants is more predictable
than root amputation and hemi sectioning.
•Mobility  mobile teeth are poor in terms of load carrying and
should be removed.

71. MUCOSA AT TEETH AND IMPLANTS

79. Microphotograph of a cross
section of the buccal and
coronal part of the
periodontium of a mandibular
premolar.
Note the position of the soft
tissue margin (top arrow), the
apical cells of the junctional
epithelium (center arrow) and
the crest of the alveolar bone
(bottom arrow).
The junctional epithelium is
about 2 mm long and the
supracrestal connective tissue
portion about 1 mm high.

81. Microphotograph of a buccal–
lingual section of the peri-
implant mucosa.
Note the position of the soft
tissue margin (top arrow), the
apical cells of the junctional
epithelium (center arrow), and
the crest of the marginal bone
(bottom arrow).
The junctional epithelium is
about 2 mm long and the
implant–connective tissue
interface about 1.5 mm high.