History and evolution of dental implants / academy of fixed orthodontics

HISTORY AND EVOLUTION OFHISTORY AND EVOLUTION OF
IMPLANTSIMPLANTS
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com
www.indiandentalacademy.comwww.indiandentalacademy.com

CONTENTSCONTENTS
 IntroductionIntroduction
 DefinitionsDefinitions
 History and Evolution of implants can be studied asHistory and Evolution of implants can be studied as
-The ancient era-The ancient era
- The Medieval period- The Medieval period
- The foundational period- The foundational period
- The Premodern era- The Premodern era
- The dawn of the modern era- The dawn of the modern era
- Contemporary oral implantology- Contemporary oral implantology
 Summary and ConclusionSummary and Conclusion
 References.References.

 INTRODUCTION

 Def of Implant (GPT 8 )Def of Implant (GPT 8 )
 Any object or material such as an alloplastic substance orAny object or material such as an alloplastic substance or
other tissue, which is partially or completely inserted orother tissue, which is partially or completely inserted or
grafted into the body for therapeutic, diagnostic, prosthetic orgrafted into the body for therapeutic, diagnostic, prosthetic or
experimental purposes.experimental purposes.
 Def of ImplantologyDef of Implantology
 Term historically conceived as the study or science ofTerm historically conceived as the study or science of
planning and restoring dental implants.planning and restoring dental implants.

 Def of Dental ImplantDef of Dental Implant
 A prosthetic device made of alloplastic material implanted intoA prosthetic device made of alloplastic material implanted into
the oral tissues beneath the mucosal or/ & periosteal layerthe oral tissues beneath the mucosal or/ & periosteal layer
&/or within the bone to provide retention & support for a fixed&/or within the bone to provide retention & support for a fixed
or removable dental prosthesis ;a substance that is placed intoor removable dental prosthesis ;a substance that is placed into
or / & upon the jaw bone to support a fixed or removableor / & upon the jaw bone to support a fixed or removable
dental prosthesis.dental prosthesis.
 Def. Of OsseointegrationDef. Of Osseointegration
 The apparent direct attachment or connection of osseousThe apparent direct attachment or connection of osseous
tissue to an inert, alloplastic material without interveningtissue to an inert, alloplastic material without intervening
connective tissue.connective tissue.

 ANCIENT ERA - 1000 A.DANCIENT ERA - 1000 A.D

 History of dentistry….3000 B.CHistory of dentistry….3000 B.C ..
 HISTORY TRACED IN MIDDLE EASTHISTORY TRACED IN MIDDLE EAST
 In 1862 Gaillardot discovered a prosthodontic appliance near the ancientdiscovered a prosthodontic appliance near the ancient
city of Sidon. Appliance was dating 400 B.C period .city of Sidon. Appliance was dating 400 B.C period .
 Carved ivory tooth replacing the two missing incisors.Carved ivory tooth replacing the two missing incisors.

 HISTORY TRACED IN THE EGYPTIANHISTORY TRACED IN THE EGYPTIAN
DYNASTIESDYNASTIES
 Evidences have shown the implantation of animalEvidences have shown the implantation of animal
teeth & artificial teeth carved of ivory .teeth & artificial teeth carved of ivory .
 Implantation prior to mummification.Implantation prior to mummification.

 In 1981 evidences of oldest dental implant was found in theIn 1981 evidences of oldest dental implant was found in the
Kalavak Necropolis, near Izmir , Turkey.Kalavak Necropolis, near Izmir , Turkey.
 The discoveries were dated back to 550 B.C . A canine toothThe discoveries were dated back to 550 B.C . A canine tooth
like object made of two piece of calcite having hardnesslike object made of two piece of calcite having hardness
similar to natural teeth showing wear on the chewing surfacesimilar to natural teeth showing wear on the chewing surface
& secured with gold wires wrapped around the neck of& secured with gold wires wrapped around the neck of
adjacent teeth.adjacent teeth.

 Cranin suggested that earliest recorded dental implant specimen wasCranin suggested that earliest recorded dental implant specimen was
inserted during theinserted during the PRE COLUMBIAN ERA.ERA.
 In 1931 Wilson Popenoe discovered a skull in the Ulua river valley ofIn 1931 Wilson Popenoe discovered a skull in the Ulua river valley of
Honduras , dating to the periodHonduras , dating to the period 600 A.D600 A.D ..
 Skull had an artificial tooth replacing lower left lateral incisor, carved of aSkull had an artificial tooth replacing lower left lateral incisor, carved of a
dark stone . Radiographs showed the evidence of compact bone around thedark stone . Radiographs showed the evidence of compact bone around the
implant.implant.
 The Mayans practiced the implantation of alloplastic materials in living persons.The Mayans practiced the implantation of alloplastic materials in living persons.

 MEDIEVAL PERIOD (1000-1799 A.D)

 Allotransplantation (18 -19 Century) mainly inAllotransplantation (18 -19 Century) mainly in
England & Colonial America.England & Colonial America.
 Albucasis de Condue ( 936- 1013 A.D) anAlbucasis de Condue ( 936- 1013 A.D) an
Arab surgeon described the transplantationArab surgeon described the transplantation
procedures . He attempted to use ox bone toprocedures . He attempted to use ox bone to
replace missing teeth.replace missing teeth.

 In Japan in the 15In Japan in the 15thth
& 16& 16thth
C. Wooden dowel &C. Wooden dowel &
crown prosthesis was designed . The pin inserted intocrown prosthesis was designed . The pin inserted into
the root canal of non vial teeth.the root canal of non vial teeth.
 This was an earlyThis was an early ENDODONTIC IMPLANT –ENDODONTIC IMPLANT –
SUPPORTED PROSTHESIS.SUPPORTED PROSTHESIS.

• Charles Allen in 1687Charles Allen in 1687 gavegave tthe first written work onhe first written work on
dentistrydentistry..
• He described the replanting of tooth into the same patient.He described the replanting of tooth into the same patient.
• Allen emphasized on transplantation of tooth using animalAllen emphasized on transplantation of tooth using animal
tooth.tooth.
• In European sphere transplantation became the commonIn European sphere transplantation became the common
practice performed by barber surgeons of the Era.practice performed by barber surgeons of the Era.
• The tooth transplant could lead to transfer of diseases .The tooth transplant could lead to transfer of diseases .
• Implants made from ivory, shells & bone were used.Implants made from ivory, shells & bone were used.

• Ambroise PareAmbroise Pare, a French physician , a surgeon to four kings, a French physician , a surgeon to four kings
of France.of France.
• He replaced the missing teeth with implants made up of boneHe replaced the missing teeth with implants made up of bone
& ivory .& ivory .
• He successfully replaced missing tooth of Princess byHe successfully replaced missing tooth of Princess by
transplanting.transplanting.

 John Hunter in 1728 – 1793John Hunter in 1728 – 1793
A.D suggested theA.D suggested the
possibility of transplanting.possibility of transplanting.

 THE FOUNDATION PERIOD (1800-THE FOUNDATION PERIOD (1800-
1910)1910)

 The endosseous oral implantology truly began in the 19The endosseous oral implantology truly began in the 19thth
Century.Century.
 Maggilio in 1809 ,Maggilio in 1809 , a dentist at the university of Nancy , France, author ofa dentist at the university of Nancy , France, author of
the book called “the book called “THE ART OF THETHE ART OF THE DENTISTDENTIST”. The first reference to”. The first reference to
modern style implants.modern style implants.
 He has described the implant & placement.He has described the implant & placement.
 He made the tooth root shaped implant with 18 carat gold with threeHe made the tooth root shaped implant with 18 carat gold with three
prongs at the end to hold it in place in the bone . The implant was placed inprongs at the end to hold it in place in the bone . The implant was placed in
the freshly extracted socket site retained with the prongs. After the tissuesthe freshly extracted socket site retained with the prongs. After the tissues
healed the crown was attached with the help of post placed into the holehealed the crown was attached with the help of post placed into the hole
of root section of the implant.of root section of the implant.
 He placed the single stage gold implant.He placed the single stage gold implant.

 In mid 1800s advancement in the antiseptics & surgicalIn mid 1800s advancement in the antiseptics & surgical
techniques , there were documentation of implanted materials.techniques , there were documentation of implanted materials.
 W. J . YoungerW. J . Younger of San Francisco introduced operations inof San Francisco introduced operations in
United States. In 1893 he wrote that his operation hasUnited States. In 1893 he wrote that his operation has
successfully entered 8successfully entered 8thth
year of life.year of life.

 In 1886 HarrisIn 1886 Harris treated a Chinese patient in Grass valley ,treated a Chinese patient in Grass valley ,
California . He placed the tooth root shaped platinum postCalifornia . He placed the tooth root shaped platinum post
with lead coating, lasted for 27 yrs Reported in Dentalwith lead coating, lasted for 27 yrs Reported in Dental
Cosmos in 1887.Cosmos in 1887.
 InIn 1889 Edmunds1889 Edmunds of New York reported on March 12 ,1889of New York reported on March 12 ,1889
to the First District dental society of that city. He implantedto the First District dental society of that city. He implanted
the metallic capsule.the metallic capsule.

 In 1888 BerryIn 1888 Berry reported about the root form implants made upreported about the root form implants made up
of lead.of lead.
 In 1890 , a Massachusetts ministerIn 1890 , a Massachusetts minister had his lower jawhad his lower jaw
resected & was restored with an extensive system of goldresected & was restored with an extensive system of gold
crowns soldered & joined to hinged device attached to thecrowns soldered & joined to hinged device attached to the
remaining dentition .remaining dentition .
 Znamenski in 1891Znamenski in 1891 reported on implantation made ofreported on implantation made of
Porcelain, gutta-percha & rubber.Porcelain, gutta-percha & rubber.

 Bonwill in 1895Bonwill in 1895 reported on the implantation of one or tworeported on the implantation of one or two
tubes of gold or Iridium as a support for individual teeth ortubes of gold or Iridium as a support for individual teeth or
crown.crown.
 IN 1898 R. E PayneIN 1898 R. E Payne at the National Dental Associationat the National Dental Association
meeting gave the first clinical demonstration by placing themeeting gave the first clinical demonstration by placing the
silver capsule in the extracted tooth socket.silver capsule in the extracted tooth socket.

 PREMODERN ERA ( 1910-1930)PREMODERN ERA ( 1910-1930)

 The first two decades of 20The first two decades of 20thth
C. predominated by the cliniciansC. predominated by the clinicians
namely R.E Payne& E. J .Greenfield.namely R.E Payne& E. J .Greenfield.
 R. E .Payne presented his technique of capsule implantation atR. E .Payne presented his technique of capsule implantation at
the clinics of Third international Dental Congress, reported inthe clinics of Third international Dental Congress, reported in
the Dental Cosmos in 1901.the Dental Cosmos in 1901.
 Technique- Extracting the root , enlarging the socket withTechnique- Extracting the root , enlarging the socket with
trephine, trial fitting of the capsule. He then placed grooves ontrephine, trial fitting of the capsule. He then placed grooves on
both sides of the socket & filled 2/3rds with rubber, fitted theboth sides of the socket & filled 2/3rds with rubber, fitted the
porcelain root into the capsule & set it with gutta-percha.porcelain root into the capsule & set it with gutta-percha.
 In 1903 Sholl in Pennsylvania , implanted porcelain tooth withIn 1903 Sholl in Pennsylvania , implanted porcelain tooth with
corrugated porcelain root.corrugated porcelain root.

 In 1913 Dr. Edward J. Greenfield came up with theIn 1913 Dr. Edward J. Greenfield came up with the
surgical method to prepare osteotomy in the healed bonesurgical method to prepare osteotomy in the healed bone
using trephine.using trephine.
 He fabricated the hollow cylindrical basket root of 20He fabricated the hollow cylindrical basket root of 20
gauge iridioplatinum soldered with 24 carat gold.gauge iridioplatinum soldered with 24 carat gold.
Precursor of hollow basket designPrecursor of hollow basket design

 GREENFIELD EMPHASIZED ONGREENFIELD EMPHASIZED ON
 The importance of intimate contact between bone & implant.The importance of intimate contact between bone & implant.
Hollow implants facilitated growth of bone into implant body &Hollow implants facilitated growth of bone into implant body &
secure it.secure it.
 3 months period of unloading.3 months period of unloading.
 Implants failures because of infection.Implants failures because of infection.
 His techniques were similar to present concepts of osteotomyHis techniques were similar to present concepts of osteotomy
preparation, restoring after healing timepreparation, restoring after healing time

 InIn 1920s Leger- Dorez1920s Leger- Dorez developed expansible root implant, wasdeveloped expansible root implant, was
comparable to a concrete expansion bolt.comparable to a concrete expansion bolt.
 SmolonSmolon described the implant as a four part device with the shaft buried indescribed the implant as a four part device with the shaft buried in
bone with the internal threads to receive a screw , fastening the neck intobone with the internal threads to receive a screw , fastening the neck into
the shaft. the post for attaching the prosthesis.the shaft. the post for attaching the prosthesis.
 The historical basis for the internal screws provided for the retention ofThe historical basis for the internal screws provided for the retention of
prosthetic devices similar to today’s implants.prosthetic devices similar to today’s implants.
 Tomkin’s 1925 implanted porcelain teeth.Tomkin’s 1925 implanted porcelain teeth.
 Brill in 1936 inserted rubber pins in artificially prepared sockets.Brill in 1936 inserted rubber pins in artificially prepared sockets.

 THE DAWN OF THE MODERN ERATHE DAWN OF THE MODERN ERA
1935-1978 A.D1935-1978 A.D

 The modern era of implant dentistry most definitely began in the late1930sThe modern era of implant dentistry most definitely began in the late1930s
with the work of Venable, Strock , Dahl , Gershkoff & Goldberg.with the work of Venable, Strock , Dahl , Gershkoff & Goldberg.
 Venable in 1937 developed the cast Co- Chr- Mo alloy known asVenable in 1937 developed the cast Co- Chr- Mo alloy known as
Vitallium.Vitallium.
 In 1939 Alvin & Moses Strock used the Venable screw type implant.In 1939 Alvin & Moses Strock used the Venable screw type implant.

 Adams in 1937Adams in 1937 developed a submergible threadeddeveloped a submergible threaded
cylindrical implant with round bottom , smoothcylindrical implant with round bottom , smooth
gingival collar & healing cap. The ball head screwedgingival collar & healing cap. The ball head screwed
to the root was used to retain an overdenture.to the root was used to retain an overdenture.
 The components designed to flex vertically orThe components designed to flex vertically or
laterally similar to the IMZ intramobile element.laterally similar to the IMZ intramobile element.

 In 1938 Stock placed the threaded vitallium implant into theIn 1938 Stock placed the threaded vitallium implant into the
extraction socket, the first long term endosseous implant.extraction socket, the first long term endosseous implant.
 It remained firm & asymptomatic for nearly 17 years.It remained firm & asymptomatic for nearly 17 years.
 He demonstrated that the Vitallium implants were wellHe demonstrated that the Vitallium implants were well
tolerated.tolerated.

 In 1947, Formiggini developed a singleIn 1947, Formiggini developed a single
helix wire spiral implants made of stainlesshelix wire spiral implants made of stainless
steel or tantalum. Two ends of the wiresteel or tantalum. Two ends of the wire
were soldered together to form a post orwere soldered together to form a post or
neck.neck.
 Chercheve Modified by increasing theChercheve Modified by increasing the
length of the neck & double helix out oflength of the neck & double helix out of
vitallium.vitallium.
 He developed the co-coordinated system ofHe developed the co-coordinated system of
instrumentation for implant insertion.instrumentation for implant insertion.

 Marziani’s use of porcelain &Marziani’s use of porcelain &
acrylic roots to support fullacrylic roots to support full
dentures.dentures.
 In 1950 Lee’s Post design i.eIn 1950 Lee’s Post design i.e
central narrow post withcentral narrow post with
extensions.extensions.

 In 1943 Dahl in Germany developed Intramucosal orIn 1943 Dahl in Germany developed Intramucosal or
button implants – Mucosal inserts.button implants – Mucosal inserts.

 SUBPERIOSTEAL IMPLANTSSUBPERIOSTEAL IMPLANTS
 An implant structure that covers the almost entire crestal surface ofAn implant structure that covers the almost entire crestal surface of
maxillary & mandibular RAR under the soft tissue to include themaxillary & mandibular RAR under the soft tissue to include the
periosteum , with the four to six posts protruding out through gingiva andperiosteum , with the four to six posts protruding out through gingiva and
on it the complete denture will be attached.on it the complete denture will be attached.
 In 1943 Gustav Dahl placed the SP implant on maxillary RAR later onIn 1943 Gustav Dahl placed the SP implant on maxillary RAR later on
mandibular.mandibular.
 Dahl & Izikowitz described the frames placed around the teeth in partiallyDahl & Izikowitz described the frames placed around the teeth in partially
edentulous patients termed as SUPERPLANTS.edentulous patients termed as SUPERPLANTS.

FABRICATION OF SUB PERIOSTEAL IMPLANTFABRICATION OF SUB PERIOSTEAL IMPLANT
 Goldberg & Gershkoff methodGoldberg & Gershkoff method
 Make an impression of the mucosa covering the RARMake an impression of the mucosa covering the RAR
 Make model & wire template made for radiography.Make model & wire template made for radiography.
 Measurements of the soft tissue depth were derived from theMeasurements of the soft tissue depth were derived from the
radiography and model was carved & casted to produce theradiography and model was carved & casted to produce the
multifenestrated Co-Chr-Mo casting with four abutments.multifenestrated Co-Chr-Mo casting with four abutments.

 Berman introduced the Two stage surgical technique for sub periostealBerman introduced the Two stage surgical technique for sub periosteal
implant.implant.
 First step was a direct impression of the surgically exposed boneFirst step was a direct impression of the surgically exposed bone
 Second was implanting the subperiosteal frame generated from the stoneSecond was implanting the subperiosteal frame generated from the stone
cast.cast.
 Kleinschmidt developed anterior single sub periosteal implant.Kleinschmidt developed anterior single sub periosteal implant.
 Marziani reported on the fabrication of full upper & lower subperiostealMarziani reported on the fabrication of full upper & lower subperiosteal
implant.implant.

 Weinberg sectionalWeinberg sectional
subperiosteal implant.subperiosteal implant.
 Lew developed modifiedLew developed modified
technique for fitting uppertechnique for fitting upper
implants by extending theimplants by extending the
implant frame further to theimplant frame further to the
periphery.periphery.

 LinkowLinkow developed Sub periosteal implantdeveloped Sub periosteal implant
consisting of three islandsconsisting of three islands

 CT scan imaging technique used to obtain threeCT scan imaging technique used to obtain three
dimensional replica of the mandible & CAD-CAMdimensional replica of the mandible & CAD-CAM
models used for fabricating the frame work.models used for fabricating the frame work.
 Long term success only 50 to 60%.Long term success only 50 to 60%.

ONE STAGE ENDOSTEAL PINS, SCREWS, &ONE STAGE ENDOSTEAL PINS, SCREWS, &
CYLINDERSCYLINDERS
 The early 1960s marked the beginning of an activeThe early 1960s marked the beginning of an active
developmental era in implant design.developmental era in implant design.
 ScialomScialom developed a tantalumdeveloped a tantalum tripodal pintripodal pin ..
 Three intersecting pins were joined by acrylic to support theThree intersecting pins were joined by acrylic to support the
crown. Difficulty in maintaining the trifurcation limited thecrown. Difficulty in maintaining the trifurcation limited the
comfortable survival.comfortable survival.

 In 1960 Onlay developedIn 1960 Onlay developed
Virilium posts placed intoVirilium posts placed into
endodonticaly treated teethendodonticaly treated teeth
extending beyond the apex.extending beyond the apex.

SCREW TYPE IMPLANTSCREW TYPE IMPLANT
 Tramonte introduced a stress resistant drive screw implant.Tramonte introduced a stress resistant drive screw implant.
 Meglan & Lehman reported on the expandable implants.Meglan & Lehman reported on the expandable implants.
 Lew introduced a self tapping Vitallium screw implant with conventionalLew introduced a self tapping Vitallium screw implant with conventional
threads & square post.threads & square post.
 Muratori & Pasquallini introduced hollow cores along with the screwMuratori & Pasquallini introduced hollow cores along with the screw
threads.threads.
 The majority of these screw shaped implants were one piece & were notThe majority of these screw shaped implants were one piece & were not
submerged , did not osseointegrate .It was emphasized that the fibrous perisubmerged , did not osseointegrate .It was emphasized that the fibrous peri
implant membrane with its shock absorbing feature preferred than boneimplant membrane with its shock absorbing feature preferred than bone
fusing to implant.fusing to implant.

 In 1963 Dr. Linkow , American DentistIn 1963 Dr. Linkow , American Dentist
developed first screw type of implant –developed first screw type of implant –
Vent Plant.Vent Plant.
 This was the first self tapping , selfThis was the first self tapping , self
threading implant . It had an open cagethreading implant . It had an open cage
like design that went into bone first , withlike design that went into bone first , with
a few threads on solid body at the top. Hea few threads on solid body at the top. He
used Vitallium first latter on titanium.used Vitallium first latter on titanium.

BLADE IMPLANTSBLADE IMPLANTS
 Linkow blade implants invented in 1967.Linkow blade implants invented in 1967.
 Long thin blade that will be surgically inserted into the grooveLong thin blade that will be surgically inserted into the groove
in the bone .in the bone .
 Abutment projecting out from the blade to this crown orAbutment projecting out from the blade to this crown or
attachment for denture can be placed.attachment for denture can be placed.
 It required the shared support of natural teeth also.It required the shared support of natural teeth also.
 Restored within month so became most widely used in unitedRestored within month so became most widely used in united
states.states.
 Linkow modified the design configuration for broadLinkow modified the design configuration for broad
applicability in maxilla & mandible, narrow ridges.applicability in maxilla & mandible, narrow ridges.

 In 1970 Roberts & Roberts developed Ramus bladeIn 1970 Roberts & Roberts developed Ramus blade
implants .implants .
 It was to be positioned by anchoring distallyIt was to be positioned by anchoring distally
between the cortical plates in the ramus of thebetween the cortical plates in the ramus of the
mandiblemandible

 RAMUS FRAME IMPLANTRAMUS FRAME IMPLANT developeddeveloped Roberts &Roberts &
Roberts in 1970 .Roberts in 1970 .
 The endosseous implant received stabilization from itsThe endosseous implant received stabilization from its
anchorage in ramus area bilaterally & in the symphysealanchorage in ramus area bilaterally & in the symphyseal
region.region.

TRANSOSTEAL IMPLANTSTRANSOSTEAL IMPLANTS
 In 1975 Small introduced the transosteal mandibullar staple &In 1975 Small introduced the transosteal mandibullar staple &
bone plate, a reconstructive device placed through a submentalbone plate, a reconstructive device placed through a submental
incision & attached to the mandible with multiple fixation &incision & attached to the mandible with multiple fixation &
two transosteal screws to support a full arch prosthesis.two transosteal screws to support a full arch prosthesis.
 He presented 16 yrs evaluation,He presented 16 yrs evaluation,

Cranin developed single transosteal implant.Cranin developed single transosteal implant.

 In 1970 Kawahara was developing a ceramicIn 1970 Kawahara was developing a ceramic
implant in Japan .implant in Japan .
 first Aluminium oxide implant placed.first Aluminium oxide implant placed.
 In 1970 Grenoble placed Vitreous CarbonIn 1970 Grenoble placed Vitreous Carbon
implant .implant .

 CONTEMPORARY ORALCONTEMPORARY ORAL
IMPLANTOLOGY 1978 to presentIMPLANTOLOGY 1978 to present

 In 1978 conference held atIn 1978 conference held at
Harward , co- sponsored by NIH.Harward , co- sponsored by NIH.
 This was the milestone for furtherThis was the milestone for further
research.research.

 In 1976 Dr. Andre Schroeder in Switzerland reported theIn 1976 Dr. Andre Schroeder in Switzerland reported the
bone growth into titanium plasma sprayed hollowbone growth into titanium plasma sprayed hollow
endosseous implants.endosseous implants.
 At the same time , Prof. Willischulte in Germany reported theAt the same time , Prof. Willischulte in Germany reported the
success with immediate placement of Vitreous Carbon implantsuccess with immediate placement of Vitreous Carbon implant
after dental extraction & invented Frialit-2 implant.after dental extraction & invented Frialit-2 implant.

 Per-Ingvar BranemarkPer-Ingvar Branemark developed the two stage threaded titaniumdeveloped the two stage threaded titanium
endosseous root form implant in North America.endosseous root form implant in North America.
 ““ Vital microscopy”…Vital microscopy”…
 In 1960 at Gothenburg…In 1960 at Gothenburg…
 Branemark noticed that there was no inflammatory reaction to theBranemark noticed that there was no inflammatory reaction to the
titanium.titanium.

 He started thinking about the potential of titanium toHe started thinking about the potential of titanium to
act as an anchorage point, so the spur for the nextact as an anchorage point, so the spur for the next
experiment whether titanium can be used as a bridgeexperiment whether titanium can be used as a bridge
in bone healing application.in bone healing application.
 Concept of Osseo integration developedConcept of Osseo integration developed
 The first clinical trail was done in 1965.The first clinical trail was done in 1965.
 In 1971 surgical equipments.In 1971 surgical equipments.
 In May 1982 Dr. George Zarb organized theIn May 1982 Dr. George Zarb organized the
Toronto conference on osseointegration. BranemarkToronto conference on osseointegration. Branemark
presented Two stage threaded root form implantpresented Two stage threaded root form implant
along with the 15 yrs research work & clinical trail.along with the 15 yrs research work & clinical trail.

BRANEMARK SYSTEM COMPONENTSBRANEMARK SYSTEM COMPONENTS
 FIXTUREFIXTURE ––
 pure titanium with machinedpure titanium with machined
threads .threads .
 The top of the fixture hasThe top of the fixture has
hexagonal design & threads ..hexagonal design & threads ..
 The apical portion tapered withThe apical portion tapered with
four vertical notches.four vertical notches.
 COVER SCREW-COVER SCREW- seals theseals the
coronal potion of fixture duringcoronal potion of fixture during
the interim period.the interim period. www.indiandentalacademy.comwww.indiandentalacademy.com

 ABUTMENTABUTMENT-- -made of titanium in a cylinder-made of titanium in a cylinder
shape. the apical portion has hexagonal shapeshape. the apical portion has hexagonal shape
to fit the coronal portion of fixture.to fit the coronal portion of fixture.

 ABUTMENT SCREWABUTMENT SCREW – insert through the– insert through the
abutment & threads into the fixture to connect theabutment & threads into the fixture to connect the
two components .two components .
 GOLD CYLINDER-GOLD CYLINDER- made of lAu , Pl, Pd. It ismade of lAu , Pl, Pd. It is
machined to fit the coronal portion of the abutment. Itmachined to fit the coronal portion of the abutment. It
becomes integral part of final prosthesis.becomes integral part of final prosthesis.
 GOLD SCREWGOLD SCREW –inserted through the gold cylinder–inserted through the gold cylinder
& threads into the abutment screw to connect the gold& threads into the abutment screw to connect the gold
cylinder & abutment.cylinder & abutment.

IMZ IMPLANT SYSTEMIMZ IMPLANT SYSTEM
 Kirsch developed the IMZ implant system in 1974.Kirsch developed the IMZ implant system in 1974.
Since 1978 in clinical use.Since 1978 in clinical use.
 Intramobile cylinder endosseous two stageIntramobile cylinder endosseous two stage
osseointegrated implant.osseointegrated implant.
 The polyoxymethylene & polyacetal used as IME.The polyoxymethylene & polyacetal used as IME.
 Available in 3.5 to 4mm diameter andAvailable in 3.5 to 4mm diameter and
8,10,13,15mm length.8,10,13,15mm length.
 Surface coating may be titanium plasma spray orSurface coating may be titanium plasma spray or
plasma sprayed HA coated surface.plasma sprayed HA coated surface.

IMZ IMPLANT SYSTEMIMZ IMPLANT SYSTEM
 Kirsch developed the IMZ implant system in 1974. SinceKirsch developed the IMZ implant system in 1974. Since
1978 in clinical use.1978 in clinical use.
 Intramobile cylinder endosseous two stage osseointegratedIntramobile cylinder endosseous two stage osseointegrated
implant.implant.
 The polyoxymethylene & polyacetal used as IME.The polyoxymethylene & polyacetal used as IME.
 Available in 3.5 to 4mm diameter and 8,10,13,15mm length.Available in 3.5 to 4mm diameter and 8,10,13,15mm length.
 Surface coating may be titanium plasma spray or plasmaSurface coating may be titanium plasma spray or plasma
sprayed HA coated surface.sprayed HA coated surface.

LEDERMAN SCREW IMPLANTLEDERMAN SCREW IMPLANT
 In 1977 Dr. Philippe Lederman in collaboration with straumanIn 1977 Dr. Philippe Lederman in collaboration with strauman
co. developed the Titanium plasma spraed screw type implant.co. developed the Titanium plasma spraed screw type implant.
 In 1989 Lederman developed the New Ledreman screwIn 1989 Lederman developed the New Ledreman screw
implant Surface roughened by sand blasting & acid etching.implant Surface roughened by sand blasting & acid etching.

ITI BONE FIT IMPLANT SYSTEMITI BONE FIT IMPLANT SYSTEM
 Developed by ‘International Team for Implantology’.Developed by ‘International Team for Implantology’.
 Three different typesThree different types
 Single stage & two stage.Single stage & two stage.
 Transgingivally placed in healing phase so second surgicalTransgingivally placed in healing phase so second surgical
procedure for uncovering the implant is avoided.procedure for uncovering the implant is avoided.

THE HAND-TITANIUM IMPLANT SYSTEMTHE HAND-TITANIUM IMPLANT SYSTEM
 Clinical use since 1985 at Switzerland & now in use worldClinical use since 1985 at Switzerland & now in use world
wide ( Lederman 1986).wide ( Lederman 1986).
 A conical, step- screw, pure Ti implant with self thread.A conical, step- screw, pure Ti implant with self thread.
 Length- 10 to 20mm.Length- 10 to 20mm.
 Diameter – 3.5 to 7mm.Diameter – 3.5 to 7mm.

 In early 1980s Tantum introduced Omni R implant -In early 1980s Tantum introduced Omni R implant -
A Ti root form implant with horizontal fins.A Ti root form implant with horizontal fins.
 Omni S implant – for placing into bone graftedOmni S implant – for placing into bone grafted
maxillary sinus.maxillary sinus.

 In 1983 EL Blasty & Kamel introduced the new endosseousIn 1983 EL Blasty & Kamel introduced the new endosseous
implant material i.e Poly acrylic acid reinforced with ceramicimplant material i.e Poly acrylic acid reinforced with ceramic
alumina particles 0.3 microns.alumina particles 0.3 microns.
 The hydrophilic matrix swells in contact with aqueousThe hydrophilic matrix swells in contact with aqueous
solution.solution.
 The gradual pressure on the surrounding bone stimulatesThe gradual pressure on the surrounding bone stimulates
osseous activity.osseous activity.
 Implanted in canine, premolar sites with promising results.Implanted in canine, premolar sites with promising results.

MINI DENTAL IMPLANTMINI DENTAL IMPLANT
 In 1985In 1985 Victor SendaxVictor Sendax developed MDI.developed MDI.
 Ultra – small diameter 1.8 mm, biocompatible Ti alloy implantUltra – small diameter 1.8 mm, biocompatible Ti alloy implant
screws.screws.
 BulardBulard added single one piece `O- ball’ design .added single one piece `O- ball’ design .

CORE VENTCORE VENT
 Developed by Dr. Gerald Niznick in 1986.Developed by Dr. Gerald Niznick in 1986.
 Hollow basket design made of Ti alloy.Hollow basket design made of Ti alloy.
 Different fixture designs Screw –Vent, Micro-Vent, Bio –Vent.Different fixture designs Screw –Vent, Micro-Vent, Bio –Vent.

ENDOPOREENDOPORE
 A root form dental implantA root form dental implant
developed by Doughlas et.al indeveloped by Doughlas et.al in
1996 made of Ti alloy &1996 made of Ti alloy &
sintered with same alloysintered with same alloy
producing porous surface.producing porous surface.
 Biological & clinical advantages.Biological & clinical advantages.

STERI OSS SYSTEMSTERI OSS SYSTEM
 Introduced by DenarIntroduced by Denar
 Made up of 99.9% Ti, tapered apex thread design & theMade up of 99.9% Ti, tapered apex thread design & the
coronal 3coronal 3rdrd
highly polished surface.highly polished surface.
 Available in 3.5 to 4mm diameter, length 12Available in 3.5 to 4mm diameter, length 12
mm,16mm,20mm,& miniseries8mm,10mm,12mm length.mm,16mm,20mm,& miniseries8mm,10mm,12mm length.

NOVUM CONCEPTNOVUM CONCEPT
 Branemark developed the concept of providing a new set ofBranemark developed the concept of providing a new set of
teeth for the mandible in a single day.teeth for the mandible in a single day.
 Clinically implicated in 1996.Clinically implicated in 1996.
 Three titanium fixtures inserted , mucosa is closed & baseThree titanium fixtures inserted , mucosa is closed & base
plate is placed over the fixtures & then the prosthesis isplate is placed over the fixtures & then the prosthesis is
placed.placed.

ZYGOMATICUS FIXTURESZYGOMATICUS FIXTURES
 Branemark.Branemark.
 The long fixture can be anchored in zygoma by approachingThe long fixture can be anchored in zygoma by approaching
through the sinus .through the sinus .
 Severely resorbed maxilla.Severely resorbed maxilla.

 1984 – CT scan.1984 – CT scan.
 Bone augmentation techniques.Bone augmentation techniques.
 1986 Tatum reported about Sinus lift / Bone graft antroplasty.1986 Tatum reported about Sinus lift / Bone graft antroplasty.
 1988 Nerve transposition1988 Nerve transposition
 1989 Pterygoid implants .1989 Pterygoid implants .
 1991 Guided tissue regeneration using Gore-Tex or1991 Guided tissue regeneration using Gore-Tex or
resorbable Vicryl-Mesh used to augment narrow & shallowresorbable Vicryl-Mesh used to augment narrow & shallow
ridges .ridges .
 1995 Distraction osteotomies & split ridge technique.1995 Distraction osteotomies & split ridge technique.

 The screw type implants fabricated by HydroxyThe screw type implants fabricated by Hydroxy
appatite based composites by mixing HA with Alappatite based composites by mixing HA with Al
oxide coated Zr oxide powder & compared withoxide coated Zr oxide powder & compared with
Cp.Ti implants.Cp.Ti implants.
 HA based composites showed better mechanicalHA based composites showed better mechanical
properties & bioactivity.properties & bioactivity.
 (Young Min Kong et.al 2002).(Young Min Kong et.al 2002).

 Development of implants coated with BioactiveDevelopment of implants coated with Bioactive
Alumina –based composite by electrophoreticAlumina –based composite by electrophoretic
deposition method.deposition method.
 Alumina is excellent biomaterial ,goodAlumina is excellent biomaterial ,good
biocompatibility , highly corrosion resistance, highbiocompatibility , highly corrosion resistance, high
wear resistance & strength.wear resistance & strength.
 Wollastonite has (CaO. SiO2) high apatite formingWollastonite has (CaO. SiO2) high apatite forming
ability deposited into the pores of foamed Alumina byability deposited into the pores of foamed Alumina by
Electrophoretic deposition.Electrophoretic deposition.

BICORTICAL SCREW IMPLANTBICORTICAL SCREW IMPLANT
 Self tapping typeSelf tapping type
 Diameter 2.5, 3.5 ,4.5,5.5mmDiameter 2.5, 3.5 ,4.5,5.5mm
 Length 21 -30mmLength 21 -30mm
 Post extraction insertion for singlePost extraction insertion for single
tooth replacement.tooth replacement.

OSTEOPLATE 2000OSTEOPLATE 2000
 Atrophic RARAtrophic RAR
 The conical plate withThe conical plate with
shoulder width 1.3 mmshoulder width 1.3 mm
& base 0.9 mm.& base 0.9 mm.

 Historically dental restorations supported by OsseointegratedHistorically dental restorations supported by Osseointegrated
implants evolved asimplants evolved as
 Fully ed. Mandibular arch -1980Fully ed. Mandibular arch -1980
 Fully ed. Maxillary archFully ed. Maxillary arch
 Short span ed. Segment -1990Short span ed. Segment -1990
 Missing single tooth – 1990Missing single tooth – 1990
 1980s restorations were screw retained , 1990s cemented.1980s restorations were screw retained , 1990s cemented.

SummarySummary
 Before 1000 A.D tooth carved of stones , calcite, ivory wereBefore 1000 A.D tooth carved of stones , calcite, ivory were
implanted.implanted.
 In the 1000 -1799 A.D mainly allotransplantation.In the 1000 -1799 A.D mainly allotransplantation.
 In the 1800-1910 period beginning of root form endosseousIn the 1800-1910 period beginning of root form endosseous
implant of Au, Pt .implant of Au, Pt .
 In the 1910-1935 Greenfeild designed hollow basket implant.In the 1910-1935 Greenfeild designed hollow basket implant.
 In 1935- 1978 Root form implants of the pin & screw type,In 1935- 1978 Root form implants of the pin & screw type,
Sub periosteal , Ramus blade, Ramus frame, Transosteal.Sub periosteal , Ramus blade, Ramus frame, Transosteal.
 In 1978 Branemark developed the Titanium implants, latter onIn 1978 Branemark developed the Titanium implants, latter on
different surface treated Ti implants developed.different surface treated Ti implants developed.

 CONCLUSSIONCONCLUSSION

REFERENCESREFERENCES
 Block & Kent’s Endosseous Implants For MaxillofacialBlock & Kent’s Endosseous Implants For Maxillofacial
Reconstruction.Reconstruction.
 Elaine Mc Clarence ’s Close to the edge.Elaine Mc Clarence ’s Close to the edge.
 Hubertus Spikerman’s Color atlas of Dental medicineHubertus Spikerman’s Color atlas of Dental medicine
(Implantology).(Implantology).
 Malvin E. Ring’s Dentistry An Illustrated History.Malvin E. Ring’s Dentistry An Illustrated History.
 Sumiya Hobo’s oseointegration and occlusal rehabilitation.Sumiya Hobo’s oseointegration and occlusal rehabilitation.
 Ralph V. McKinney, Jr’s endosteal dental implants.Ralph V. McKinney, Jr’s endosteal dental implants.
 ADA council on scientific affairs Dental endosseous implants.
An update. JADA, Vol. 135, January 2004.

 Richard M. Sullivan, Implant Dentistry and the Concept of Osseointegration: A
Historical Perspective .(2001) Journal of the California Dental Association.
 Douglas A. Deporter “simplifying the treatment of edentulousness” JADA Vol
121sept 1996:1343
 Young-Min Kong, Hydroxyapatite-Based Composite for Dental Implants: an In
Vivo Removal Torque Experiment. J Biomed Mater Res (Appl Biomater) 63: 714–
721, 2003
 M. A. EL BASTY and I. L. KAMEL.The Development of a Novel Tooth-root
Implant Material. J Dent Res 62(6):733-737, June 1983
 Management of atrophic mandibular ridges with Mini dental implant systems- A
case report J.IPS;2005;5;158.

Thank you
For more details please visit
www.indiandentalacademy.com

History and evolution of dental implants / academy of fixed orthodontics

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