History & evolution of implants / cosmetic dentistry training

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INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com
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CONTENTS
 INTRODUCTION
 TERMINOLOGY
 HISTORY OF IMPLANTOLOGY
-The ancient era
- The Medieval period
- The foundational period
- The Premodern era
- The dawn of the modern era
- Contemporary oral implantology
 CLASSIFICATION OF IMPLANTS
 THE FUTURE
 REVIEW OF LITERATURE
 CONCLUSION
 REFERENCES
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TERMINOLOGY:-TERMINOLOGY:-
 IMPLANT:-Any object or material, such as an
alloplastic substance or other tissue, which partially
or completely inserted or grafted into body for
therapeutic, diagnostic, prosthetic or experimental
purposes.
4

 DENTAL IMPLANT:-A prosthetic device or
alloplastic material implanted into oral
tissues beneath the mucosal or periosteal
tissues, and onor with in the bone to
provide retention and support for fixed or
removal prosthesis.
5

 IMPLANT ABUTMENT:-The portion of dental
implant that serves to support andor retain
any prosthesis.
6

 IMPLANT BODY:-The portion of the
implant that provides support for the
abutments, through adaptation upon
within in or through the bone.
7

 ENDOSTEAL IMPLANT:-
A device placed into the alveolar and/or
basal bone of mandible or maxilla and
transecting only one cortical plate.
8

 TRANSOSTEAL IMPLANT:-
A dental implant that
penetrates both cortical
plates and passes through
the full thickness of alveolar
bone.
They are also called as
staple bone implant,
mandibular staple implant,
trans mandibular implant 9WWW.INDIANDENTALACADEMY.COM

 SUBPERIOSTEAL DENTAL IMPLANT:-
A cast metal frame work that fits on
the residual ridge beneath the
periosteum and provide support for
a dental prosthesis by means of
posts or other mechanisms
protruding through the mucosa.
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 OSSEOINTEGRATION:-
The apparent direct attachment or
connection of osseous tissue to an inert
alloplastic material without intervening
connective tissue.
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12
•The ancient era (through AD 1000).
•The medieval period (1000-1799).
•The foundational period (1800-1910)
•The premodern era (1910-1930)
•The dawn of the modern era (1935-1978)
•Contemporary oral implantology (1978 to
present)
HISTORY OF IMPLANTOLOGY:

THE ANCIENT ERA (THROUGH AD 1000):THE ANCIENT ERA (THROUGH AD 1000):
 The earliest recorded implant specimen is
from 600A.D from the Mayan civilization
in south America.
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 Dental implant and transplant history can also be
traced in-
 Africa (Egyptians),
 to the Americans (Mayans, Aztecs, and Incans),
 and to the Middle East.
14

HISTORY TRACED IN THE EGYPTIAN DYNASTIES
 Evidences have shown the implantation of
animal teeth & artificial teeth carved of ivory .
 Implantation prior to mummification
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 In 1981 evidences of oldest dental implant was
found in the Kalavak Necropolis, near Izmir , Turkey.
 The discoveries were dated back to 550 B.C . A
canine tooth like object made of two piece of calcite
having hardness similar to natural teeth showing
wear on the chewing surface & secured with gold
wires wrapped around the neck of adjacent teeth.
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 HISTORY TRACED IN MIDDLE EAST
 In 1862 GAILLARDOT excavated a grave site
near ancient city in sidon. Here he discovered
a prosthodontic appliance dating to 400B.C.,
consisting of four natural teeth holding
between them 2 carved ivory teeth.
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 This era was dominated with the
transplantation of teeth.
 Abul kasim an Arab surgeon, described
transplantation procedures .
 supported by such stalwarts as Pierre
Fauchard and John Hunter.
 The fear of transfer of disease, led to its
unpopularity.
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THE FOUNDATIONAL PERIOD (1800-1910):THE FOUNDATIONAL PERIOD (1800-1910):
 Beginning of Endosseous oral implantology
 MALLIGO –in 1809, inserted a gold implant
into a freshly extracted site.
 1889-implantation of a metallic capsule by
Edmunds
 1888-use of lead by berry
 1898-R.E.payne places silver capsule in the
tooth socket
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 In 1890, ZAMENSKI reported the implantation
of teeth made of porcelain, gutta-percha, and
rubber.
 EDMUNDS OF NEWYORK CITY-reported on
march 12,1889- to the first district of dental
society of that city, the implantation of metallic
capsule in the space occupied by upper right
first premolar.
21

THE PREMODERN ERA (1910-1930):THE PREMODERN ERA (1910-1930):
 The first two decades of 20th
C. predominated by the
clinicians namely R.E Payne& E. J .Greenfield.
 R. E .Payne presented his technique of capsule
implantation at the clinics of Third international Dental
Congress, reported in the Dental Cosmos in 1901.
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 Technique- Extracting the root , enlarging the
socket with trephine, trial fitting of the capsule. He
then placed grooves on both sides of the socket &
filled 2/3rds with rubber, fitted the porcelain root
into the capsule & set it with gutta-percha.
 In 1903 Sholl in Pennsylvania , implanted porcelain
tooth with corrugated porcelain root.
23

 In 1913 Dr. Edward J. Greenfield came up with the
surgical method to prepare osteotomy in the healed
bone using trephine.
 He fabricated the hollow cylindrical basket root of 20
gauge iridioplatinum soldered with 24 carat gold.
Precursor of hollow basket design.
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CONTRIBUTION OF GREENFIELD:
 First to document an implantation procedure in
the scientific literature.
 considered implant dentistry to be the “missing
link”
 emphasized the importance of sterile procedure
 concept of “Osseointegration” is discussed
 Greenfield manufactured an artificial root of 20
gauge iridoplatinum wire soldered with 24-carat
gold.
25

 Bioceram implants are composed of single
crystalline alpha aluminum oxide or poly
crystalline aluminum oxide.
 Kyocera corporation-Japan corporation makes
Bioceram implants.
 They are composed of entirely single
crystalline aluminum oxide material and are
designated as S&E type.
26

 The basic design
between two types are
they are different size
and width.

 In 1936- BRILL inserted rubber pins in artificial
prepared socket.
 In 1937-ADAMS, developed a submerged
cylindrical implant in the shape of screw.
 The implant had a rounded bottom, smooth
gingival collar and healing cap.
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THE DAWN OF THE MODERN ERA (1935-1978)THE DAWN OF THE MODERN ERA (1935-1978)
 Metal implant devices of gold, lead, iridium, tantalum,
stainless steel & cobalt alloy were developed in early 20th
century.
 In 1937 venable developed the cast cobalt-chromium-
molybdenum alloy now known as vitallium.
 In 1939 Alvin & Moses Strock used the Venable screw
type implant.
29

 Adams in 1937 developed a submergible
threaded cylindrical implant with round
bottom , smooth gingival collar & healing
cap. The ball head screwed to the root was
used to retain an overdenture.
30

 In 1938 Stock placed the threaded vitallium implant
into the extraction socket, the first long term
endosseous implant.
 It remained firm & asymptomatic for nearly 17 years.
 He demonstrated that the Vitallium implants were
well tolerated.
31

 In 1947, Formiggini developed a single
helix wire spiral implants made of
stainless steel or tantalum. Two ends
of the wire were soldered together to
form a post or neck.
 Chercheve Modified by increasing
the length of the neck & double helix
out of vitallium.
 He developed the co-coordinated
system of instrumentation for implant
insertion.
32

 Marziani’s use of porcelain
& acrylic roots to support
full dentures.
 In 1950 Lee’s Post design
i.e central narrow post
with extensions.
33

 In 1943 Dahl in Germany developed Intramucosal or
button implants – Mucosal inserts.
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 Osseointegration:- defined by
the American Academy of Implant Dentistry as
"the firm, direct and lasting biological
attachment of a metallic implant to vital bone
with no intervening connective tissue."
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HISTORY:
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IMPLANTS AND PROVISIONAL PROSTHESIS IN DOGS MOUTH
PERMANENT
PROSTHESIS

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HOW MUCH LOAD COULD THIS IMPLANT WITHSTAND ?
Radiographs after
2 yrs
Before &
after
scaling
With ligature tied to
implants

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Anchorage Capacity Of The
Integrated Implants Or Fixtures
Was Shown By Suspending The
Dog Via Wires Connected To The
Fixtures

43
Microcirculation in humans by vital microscopy in implanted
titanium optical chambers in twin pedicled skin tubes
Basic research with titanium optical microscopes in humans were
performed to study the behaviour of blood as a mobile tissue.
Studies in human hands were successful and Branemark’s team
decided to start up with clinical trails in oral cavity.
Maintained integration
of the chamber in skin
tube

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BRANEMARK AND TEAM WENT AHEAD WITH
Ist TRAILS IN HUMAN BEINGS IN 1965
Branemark Was Greeted By:
1) Disbelief
2) Clinically unworkable or not practical
3) Ridicule & mockery
Eg : Consensus development conference on osseointegration
• 4000 implants
• 20 years of basic research
• 10 years of clinical follow-up

SUBPERIOSTEAL IMPLANTS:SUBPERIOSTEAL IMPLANTS:
 An implant structure that covers the almost entire crestal surface of
maxillary & mandibular RAR under the soft tissue to include the
periosteum , with the four to six posts protruding out through gingiva
and on it the complete denture will be attached.
 In 1943 Gustav Dahl placed the SP implant on maxillary RAR later on
mandibular.
 Dahl & Izikowitz described the frames placed around the teeth in
partially edentulous patients termed as SUPERPLANTS.
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FABRICATION OF SUB
PERIOSTEAL IMPLANT
 Goldberg & Gershkoff method
 Make an impression of the mucosa covering
the RAR
 Make model & wire template made for
radiography.
 Measurements of the soft tissue depth were
derived from the radiography and model was
carved & casted to produce the
multifenestrated Co-Chr-Mo casting with
four abutments.
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 Berman introduced the Two stage surgical technique for sub
periosteal implant.
 First step was a direct impression of the surgically exposed bone
 Second was implanting the subperiosteal frame generated from
the stone cast.
 Kleinschmidt developed anterior single sub periosteal implant.
 Marziani reported on the fabrication of full upper & lower
subperiosteal implant.
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48

 Weinberg sectional subperiosteal
implant.
 Lew developed modified technique
for fitting upper implants by
extending the implant frame further
to the periphery.
49

 Linkow developed Sub periosteal implant consisting
of three islands
50

 CT scan imaging technique used to
obtain three dimensional replica of the
mandible & CAD-CAM models used for
fabricating the frame work.
 Long term success only 50 to 60%.
51

PROCEDURE FOR THE PLACEMENT OF
SUBPERIOSTEAL IMPLANTS:
The first subperiosteal implants were fabricated from
overextended soft tissue impressions and
interpretation of intra oral periapical radiographs.
The casts of the soft tissue were scraped and modified
in accordance to the tissue thickness evaluated
from the radiographs to simulate underlying bone
topography.
52

 This technique permitted the use of only crestal bone
to support the implant.
 In surgical approach, the tissues were reflected and
the implant inserted.
 The casting did not fit accurately to the residual bone,
so screws were inserted to fix it in place.
 LEW and BERMAN began taking direct bone
impressions for the mandibular subperiosteal
implants.
53

 SUBPERIOSTEAL IMPLANTS WERE
FOLLOWED BY BLADE IMPLANTS.
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Linkow blade implants invented in 1967.
Long thin blade that will be surgically inserted into the
groove in the bone .
Abutment projecting out from the blade to this crown or
attachment for denture can be placed.
It required the shared support of natural teeth also.
Restored within month so became most widely used in
united states.
Linkow modified the design configuration for broad
applicability in maxilla & mandible, narrow ridges..
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THE TECHNIQUE INVOLVES:-THE TECHNIQUE INVOLVES:-
 Incision should be made along the
crest of the alveolar ridge.
 The incision must be long enough
to permit adequate reflection of
the tissue.
 The length and location of
proposed blade placement channel
is marked on the alveolar ridge.

 After determining the the
placement location, the
cortical plate is penetrated
with series of pilot holes 3-
4mm apart with 700XL
fissure bur.

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60

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 The holes are then connected using the same
bur.
 It is some times necessary to curve the
proposed implant to accommodate to the
curvature of the jaw at the placement.
 The channel is deepened with a fresh 700XL or
700XXL bur.
 The implant attached to the blade implant
inserter and held by the knob, is conveyed to
the surgical site.
63

 The blade component is then carefully inserted into
prepared socket.
 The blade should fit tightly into the prepared socket.
 It should also be at least 2mm below the crest of the
ridge.
 The use of tricalcium phosphate ceramic particle,
freeze dried bone, or autogeneous bone particles to fill
in any large voids recommended.
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ENDOSTEAL IMPLANTS:ENDOSTEAL IMPLANTS:
 Strock developed truly endosteal dental implants in the
1940s and was first to present the Histologic evidence of
Osseointegration.
 Formiggini, in 1947, developed the single helix wire spiral
implant.
 Zepponi, developed a cast spiral implant.
67

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50S AND 60S50S AND 60S
 was a period of trial and error
 dominated by the work of linkow
 the linkow blade or linkow blade vent, was
introduced in 1967 - an implant that
dominated the 1960s, 70s and early 80s
 Founded the American academy of implant
dentistry.
69

IN 1947- FORMIGGINI- developed the single helix wire
spiral implant made of either stainless steel or
tantalum.
IN MID 50S LEE- introduced the use of an endosseous
implant with central post and circumferential
extensions.
In 1959 LEW described the progress and evolution of
subperiosteal implants and further modified the
frame work to incorporate maximum strength and
minimum bulk.
70

 In 1960s SCIALOM- described the use of tripoidal
endosseous pin arrangement.
 They are made up of a tantalum tripoidal pin in which
three intersecting pins were joined by acrylic and
fashioned to support a crown.
 Rigid fibrous encapsulation of the pins occurred.
However survival and maintaining the trifurcation
limited.
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72

 In 1960s CHERCHEVE designed a helical implant
made of co-cr.
73
In 1960s LINKOW introduced the blade vent
implant.
In 1960s SANDHAUS developed a crystalline bone
screw-consisting mainly of aluminum oxide..

 In late 1960s ROBERTS developed ramus blade
endosseous implant.
 In early 1970s GRENOBLE introduced vitreous
carbon implants. it was first placed in the canines.
 Based upon biocompatibility and efficacy studies,
human clinical studies began on the use of this
implant in late1970s.
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TRENDS IN USAGE OF ENDOSSEOUS IMPLANTWWW.INDIANDENTALACADEMY.COM

CONTEMPORARY ORALCONTEMPORARY ORAL
IMPLANTOLOGY (1978 TOIMPLANTOLOGY (1978 TO
PRESENT)PRESENT)
 Originates with the 1978 conference held at
Harvard .
 Results of about 30 years of experimental
research in Sweden were finally put for peer
review in 1981.
 This implant was first known as Biotes and
then as the Nobelpharma implant.
76

 In early 1980s TATUM introduced the omni R
implants. this is a titanium alloy root form implant.
 In1980s DRISKELL introduced the Stryker root form
endosseous implant made of titanium alloy and
hydroxyapatite coating.
 In the 1980s cylindrical plasma spray titanium and
hydroxyapatite coated implants were introduced.
 .
77

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 The IMZ implant is a press-fit stress broken
titanium plasma sprayed cylinder, many are
hollow cylinders ( Corevent) & some are HA
coated( Integral, Calcitek,Inc).
 Plasma sprayed or other induced surface
roughness enhances bone deposition &
maintainence as well as affording an
increased surface area for stress transfer.
79

CLASSIFICATION OF IMPLANTS MATERIALSCLASSIFICATION OF IMPLANTS MATERIALS
ACCORDING TO THE TISSUES INTO WHICH THEYACCORDING TO THE TISSUES INTO WHICH THEY
ARE EMBEDDED - LEONARD. R.RUBINARE EMBEDDED - LEONARD. R.RUBIN
 Intraosseous.
 Subperiosteal
 Transosseous
 Transcanal
80

CLASSIFICATION OF IMPLANTS BY CHARLES.CLASSIFICATION OF IMPLANTS BY CHARLES.
A.BABBUSHA.BABBUSH
 There are five main types:
i. Mucosal inserts
ii. Subperiosteal implants
iii. Endodontic implants
iv. Endosseous implants
v. Transosteal implants
81

CLASSIFICATION OFCLASSIFICATION OF
IMPLANTS (IMPLANTS (DENNIS C. SMITH,DENNIS C. SMITH,
DAVID. F. WILLIAMS)DAVID. F. WILLIAMS)
1) Buried
A. Metals:
Magnets:
Endodontic stabilizers:
B. Non-metals
Recontouring procedures:
Maintenance efforts:
2) Semi buried
A.metals
B.non metals
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 Certainly it seems there is more
development & evolution to come,which will
ultimately add to history of these small
metal devices, but only until such time as
the very notion of screwing metal into bone
becomes historical itself , which it surely will
as genetic engineering gathers pace.
84

REVIEW OF LITERATURE
 Al-Omiri M, Hantash RA, Al-Wahadni A. Satisfaction with
dental implants: a literature review. Implant Dent. 2005
Dec;14(4):399-406.
 Recent years have witnessed a consistent trend toward the
introduction of patient assessment of different treatment
outcomes in dental practice. Patient satisfaction with dental
implants was considered among these treatment modalities.
Few literature reviews have been published on this topic.
This article critically analyzes the concerned topics related
to patient satisfaction with dental implant.
 A MEDLINE search was completed from 1983 to 2004, along
with a manual search, to locate related articles on the topic.
Dental implants provided promising and predictable results
regarding patient satisfaction and various aspects of life
assessment.
85

 Fenton A. The role of dental implants in the future. J Am
Dent Assoc. 1992 Jan;123(1):36-42.
 Osseointegration's documented success allowing bone
and mucosal tissue to tolerate a titanium implant has
dramatically expanded the possibilities of dental care.
We can now replace extracted teeth. Maintaining
implants is different, but simpler than tooth
maintenance.
 There is much interest in quicker procedures, shorter
healing times or other materials to see if they can be as
successful as CP titanium. Some may prove to be so.
 In any case, osseointegration has had as much impact on
20th century dentistry as local anesthetics, fluorides and
the air rotor. Our practices and curricula, are changing to
remain contemporary and ready for the 21st century.
86

 Misch CE The importance of dental implants. Gen
Dent. 2001 Jan-Feb;49(1):38-45.
 Implant dentistry has evolved into the mainstream of
restorative practices all over the world. Maintenance
of bone after tooth loss to improve or maintain facial
esthetics and improved retention, function, and
performance of removable restorations are only some
of the advantages for the edentulous patient.
 No longer are implants considered only when
traditional restorations cannot be fabricated.
Evidence-based reports indicate implant restorations
last longer than those on teeth and the abutment
teeth are at less risk of loss or complication.
87

 Demann ET, Stein PS, Haubenreich JE. Gold as an
implant in medicine and dentistry. J Long Term Eff
Med Implants. 2005;15(6):687-98.
 The purpose of this collective review is to study the
history, physical and chemical properties, application,
and clinical consequences of gold implants in the
dental and medical fields. Gold implants are used in
various medical procedures, including reconstructive
surgery of the middle ear, upper lid closure in facial
nerve paresis-induced lagophthalmos, drug delivery
microchips, antitumor treatment, treatment of
rheumatoid arthritis, use on the surface of voice
prostheses, and endovascular stents, with sound
clinical results.
88

 However, in order to achieve better therapeutic
benefits, clinical reports have documented that the
surface of gold implants have been modified or
encased in biocompatible alloplastic materials, or
they have been replaced by cheaper and more
biocompatible materials.
 Gold is also applied to a long list of dental
prostheses, including inlays, onlays, crowns, bridges,
periodontal splints, and post and cores. It has
sufficient strength and corrosion resistance, and it is
relatively biocompatible. In addition, gold dental
prostheses have a long life cycle. However, esthetic
concerns and cost make it a less desirable prosthesis
today than in the past.
89

CONCLUSION
In discussing the evolution of implants, one must consider the
objectives of
 The use of the dental implant, the nature of its design,
 The biocompatibility of materials with the oral environment,
 Research data, and
 The long-term clinical trials
which have influenced the developments of such implants.
90

REFERENCES
 1.Dental Implants The Art and Science, Charles A .
Babbush.
 2.Implants and Restorative Dentistry Carl . E . Misch.
 3. Hubertus Spikerman’s Color atlas of Dental medicine
(Implantology).
 4. Becker MJ. Department of Anthropology and Sociology,
West Chester University Ancient "dental implants": a
recently proposed example from France evaluated with
other spurious examples. Int J Oral Maxillofac Implants.
1999 Jan-Feb;14(1):19-29.
 5. Taylor TD, Agar JR. Twenty years of progress in implant
prosthodontics. J Prosthet Dent. 2002 Jul;88(1):89-95.
91

 6. Al-Omiri M, Hantash RA, Al-Wahadni A.
Satisfaction with dental implants: a literature review.
Implant Dent. 2005 Dec;14(4):399-406.
 7. Fenton A. The role of dental implants in the future.
J Am Dent Assoc. 1992 Jan;123(1):36-42.
 8. Misch CE The importance of dental implants. Gen
Dent. 2001 Jan-Feb;49(1):38-45.
 9. Demann ET, Stein PS, Haubenreich JE. Gold as an
implant in medicine and dentistry. J Long Term Eff
Med Implants. 2005;15(6):687-98.
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History & evolution of implants / cosmetic dentistry training

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