Dental Implants

Dr.Amrish Bhagol,
Associate Prof.,
Oral and Maxillofacial Surgery,PGIDS
 What is an implant ?
A dental implant ( also known as an
endosseous implant or
fixture ) :
Is a surgical component that interfaces with the
bone of the
jaw or skull to support a dental prosthesis such
as a crown ,
ridge , denture , facial prosthesis or to act as an
orthodontic
anchor .
Crown Denture

Bridge
The basis for modern dental implants is a biologic
process called osseointegration ( bone-to-implant
interface ) where
materials, such as titanium , form an intimate
bond to bone.
The implant fixture is first placed, so that it is likely
to osseointegrate, then a dental prosthetic is
added.
 A variable amount of healing time is required
for
osseointegration before either the dental
prosthetic (a crown,
bridge or denture) is attached to the implant or an
abutment
is placed which will hold a dental prosthetic.
Generally any edentulous area can be an
indication for dental implants.
 Severe morphologic compromise of denture
supporting areas that significantly
undermine denture retention.
 Poor oral muscular coordination.
 Low tolerance of mucosal tissues.
 Para-functional habits leading to recurrent
soreness and instability of prostheses.
 Active or hyper active gag reflexes, elicited
by a removable prosthesis.
 Psychological inability to wear a
removable
prosthesis even if adequate denture
retention and stability is there.
 Unfavourable number and location of
potential abutments in a residual
dentition.
 (Adjunctive location of optimally
placed
osseointegrate root analogues would
allow for provision of a fixed
prosthesis.) .
 Single tooth loss to avoid involving
neighbouring teeth as abutments.
CONTRAINDICATIONS
  Acute illness .
  Terminal illness .
  Pregnancy .
  Uncontrolled metabolic disease .
  Tumoricidal radiation including the implant site .
  History of intravenous bisphosphonate therapy .
  Unrealistic expectation .
  Improper motivation .
  Lack of operator experience .
  Unable to restore teeth prosthodontically .
  Inability of patient to manage oral hygiene.
  Patient hypersensitivity to specific components of the implant .
Classification of dental implant

1. ENDOSSEOUS .
2. SUBPERIOSTEAL .
3. TRANSOSSEOUS .
 Endosseous subdivided as follows :
– Root form.
– Blade (plate) form.
– Ramus frame.
 Subperiosteal subdivided as follows :
– Complete.
– Unilateral.
– Circumferential.
 Transosseous subdivided as follows :
– Staple.
– Single pin.
– Multiple pin
INDICATIONS FOR EACH IMPLANT
TYPE
1- ENDOSSEOUS:
a- Root form, blade (plate) form:
o Adequate bone to support the implant
with width and height being the primary
dimensions of concern.
o Maxillary and mandibular arch locations.
o Completely or partially edentulous
patients.
b- Ramus frame:
o Adequate anterior bone to support the
implant with width and height being the
primary dimensions of concern.
o Mandibular arch location.
o Completely edentulous patients.
2- SUBPERIOSTEAL
( complete, unilateral, circumferential ):
o Atrophy of bone but with adequate bone to support the
implant.
o Maxillary and mandibular arch locations.
o Completely and partially edentulous patients.
o Stable bone for support.
3- TRANSOSSEOUS:
( staple, single pin, multiple pin ):
 Adequate anterior bone to support the implant with width and
 height being the primary dimensions of concern.
 Anterior mandibular arch location.
 Completely and partially edentulous patients.
For long-term successful performance of all
dental implant types the following general
factors should be considered:

  Biomaterials.
 Biomechanics.
 Dental evaluation.
 Medical evaluation.
 Surgical requirements.
 Healing processes.
 Prosthodontics.
 Post insertion maintenance.
Generally Accepted Implant Success Criteria
 1. The individual unattached implant is immobile when tested
 clinically .
 2. No evidence of pri-implant radiolucency is present , as
 assessed on an undistorted radiograph .
 3. The mean vertical bone loss is less than 0.2 mm annually
 after the first year of service .
 4. No persistent pain , discomfort , or infection is attributable
 to the implant .
 5. The implant design does not preclude placement of a crown
 or prosthesis with an appearance that is satisfactory to the
 patient and the dentist .
The mean vertical bone loss is less than 0.2 mm
annually after the first year
of service .
Success Implant 
Vertical bone loss after 10 Ys
Implant component
1. Abutment.
2. Screw.
3. Interim abutment
4. Implant body.
Clinical implant components
Osseointegrate implant
are generally designed to
support screw and
cement-retained implant
restoration
1-Implant body .
 The dental implant body , often referred to as the
fixture , is the component placed within the bone
during first-stage surgery.
 Types of root form of implant body :
1. Threaded root form
2. Non-threaded root form
 The main categories of implant body :
1. Titanium screw .
2. Hydroxyapatite-coated screw
3. Titanium plasma-sprayed cylinder
4. Hydroxyapatite-coated cylinder
Types of root form of implant body
2- Healing Screw
 During the healing phase after first
stage surgery , a screw is
normally placed in superior aspect of
the fixture .
 The screw is usually low in profile to
facilitate the suturing of
soft tissue in two stage implant or
minimize loading in the one
stage implant
 A second stage surgery , the screw is
removed and placed by
subsequent components .
3- Interim Abutment
 Interim abutment are dome-shaped screws
placed after
second stage surgery and before insertion of
prosthesis .
 The abutments range in length from 2-10 mm and
project
through the soft tissue into the oral cavity .
 The abutments may screw directly into the fixture
or, in some
systems , onto the abutment immediately after
second stage
surgery
4- Abutments

 Abutments are the component of the implant

system that
screw directly into the implant .
 Abutments eventually support the prosthesis in
screwretained
restoration , in as much as they accept the retaining
screw of prosthesis .
 For cement retained restorations, abutments may
be shaped
like a conventional crown preparation .
 The walls of abutments are usually smooth ,
polished , and straight – sided .
 The length range from 1-10 mm
 In nonesthetic areas , 1-2 mm of titanium should
be allowed to penetrate the soft tissue to
maximize the patient’s ability to clean the
prosthesis
 The choice of abutment size depends on the
vertical distance between the fixture base and
opposing dentition , the existing sulcular depth ,
and the esthetic requirements in the area being
restored .
 For acceptable appearance , an anterior maxillary
crown may require 2-3 mm of subgingival
porcelain at the facial gingival margin to create the
proper emergence profile and appearance ,
whereas fixtures in the posterior maxilla or
mandible may have margin termination at or
below the gingival crest .
5- Impression Coping
 Impression coping facilitate transfer of the of
intraoral
location of the implant or abutment to a similar
position on
the laboratory cast .
 Impression coping may screw into the implant or
onto the
abutment and are customarily subdivided into
fixture types or
abutments types .
 Types of impression coping :
1. Transfer ( indirect ) .
2. Pickup ( direct ) .
6- implant analog
 Implant analogs are made to represent
exactly the top of the implant fixture or
the abutment in the laboratory cast .
 Therefore , analogs can be classified as
fixture analogs and abutment analogs .
 Both types of analog screw directly into
the impression coping after it has been
removed from the mouth , and the
joined components are returned to the
impression before pouring .

Abutment + Transfer r + Analog + Healing Cup
7- waxing sleeve
Waxing sleeves are attached to the
abutment by the
relating screw on the laboratory model .
 The sleeves eventually become part of
prosthesis .
 In non segmented implant crowns , the
sleeves are
attached directly to the implant body
analog in the
cast .
8- Prosthesis retaining screw
 prosthesis retaining screws
penetrate the fixed restoration and
secure it to the abutment .
 The screws are tightened with a
screwdriver and attach nonsegmented
crowns to the body of
the implant .
Basic Surgical procedure
1- Before implant placement
Successful implant placement relies on adequate
bone quantity and quality .
The availability of bone at the implant site is
based on many variables .
Some of variables controlled by the dentist
include use of :
1. Atraumatic extraction techniques .
2. Preservation of the bony socket .
3. Selection of interim prosthesis.
4. Timing of implant placement .
2- implant
placement
a) Patient preparation
b) Soft tissue incision
c) Preparation of implant site
d) Implant placement
a- Patient preparation
 Preoperative antibiotic prophylaxis is
usually recommended .
 Profound local anesthesia is required
for precise implant placement .
 The patient can rinse with 15 ml 0.12%
chlorhexidine gluconate ( Peridex ) for
30 sec immediately before the start of
surgery to reduces the oral microbial
count .
b- Soft tissue Incision
 Several types of incisions can be
used to gain access to the
residual ridge for implant
placement.
 The incision should be designed
to allow convenient retraction of
the soft tissue for unimpeded
implant placement.
 It should preserve or increase the
quantity of attached tissue and
preserve local soft tissue
esthetics .
c- Preparation of the
implant site
 After the bone is exposed the surgical guide template is
positioned, and a preliminary assessment of the implant site is
made .
 The residual ridge may have areas of unevenness or sharp
ridges
that are best reduced with a rongeur or a bur before drilling for
implant placement .
 Fibrous tissue should also be removed so that it will not be
incorporated into the implant site .
 Placement procedures for all implant systems require
atraumatic
preparation of recipient site .
 A low speed , high torque handpiece and copious irrigation are
necessary to prevent excess thermal injury to the bone .
bone is exposed the surgical guide template is
positioned
 All implant systems have an initial small diameter drill that is
used to mark the implant site .
 With that initial drill the center of implant recipient site is
marked and the initial pilot hole is prepared .
 The implant recipient site preparation continuous by drilling
with a series of gradually larger burs .
 d-Implant placement
  After the desired depth and diameter of the
recipient site is
 accomplished , the implant is placed .
  Although some implants are pressed into
place , most are
 threaded and must be screwed in place by
handpiece at very
 low speed or by hand .
  Final tightening in most cases is done by
hand with a ratchet .
  After all implants are placed , the wound is
closed .
3- post-operative care
 A radiograph should be taken postoperatively to
evaluate the position of implant in relation to
adjacent structures , such as sinus and inferior
alveolar canal , and relative to other implants .
 Patients should be provided analgesics .
 Patients can also be instructed to use 0.12%
chlorhexidine gluconate , rinse for 2 weeks after
surgery to help keep bacterial populations at a
minimum during healing .
 A patient is evaluated weekly until soft tissue
wound healing is complete ( approximately 2-3
weeks )
If the patient wears a tissue borne denture
over the area of implant placement , the
denture can be relined with soft liner after
one week and may be worn .
Interim partial dentures or orthodontic
retainers with an attached pontic may be
worn immediately but must be contoured to
avoid soft tissue loading over the implant site .
4- prosthetic stage
 After 3-4 months, at second stage surgery the implant site is
re-opened and cover screw is taken out .
 Gingival former is fitted on the implant screw for one week
 In one stage implants , cover screw and gingival former are
not required , as we directly go for prosthetic work just after
the insertion of the implant in the bone .