This presentation gives a simple review of history and types of implants. It shows the hard and soft tissue inter-relationship to implant replacements, evaluation of patients and risk factors.

1. Dr. Diana Abo El Ola

3. • It was traced back to the ancient Egyptian to replace
lost teeth by implanted materials, (hammered shaped-
seashells) into the jaws .
• Modern implant dentistry began with the introduction
of Ti implants in the 1950s.
• The first patient was successfully treated in 1965.
Branemark

4. Implant Geometry (Macrodesign)
is prosthetic device of alloplastic material implanted into
oral tissues to provide retention and support for
removable or fixed prosthesis.
Implant Surf. Characteristics (Microdesign)

5. I-Implant Geometry (Macrodesign)
A.Endosseous
implants
B.Subperiosteal
framelike
implants
C.Transmandibular
implants

6. A- Endosseous implants
Bladelike Pins Disk like
Cylindrical
(hollow/full)
Screw /threaded

7. 1-Blade implants
• in 1960- 1970s.
• inserted into the bone through a
channel(narrow trench) with one or several
posts pierced through the mucoperiosteum.
Disadv:
-Extensive bone necrosis + fibrous scar tissue
formation dt high speed drilling.
-Difficult to be removed if infection occurred.

8. 2-Pins
• Rare
• They were inserted either transgingivally or by
mucoperiosteal flap reflection .
• Disadv:
• The bone necrosis dt drilling fibrous scar,
marsupialization & loss of the implants bec. of
infections.
• BUT easily removed with minimal bone loss.

9. 3-Disk Implants
• Rarely used.
• has strong retention against vertical extraction forces.
Disadv.
• Dt high-speed drills  fibrous scar tissue+ bone loss.
• Difficult to be extracted if failed.

10. 4-Cylinderical Implants
• Have holes(vents)  ingrowth bone additional stability.
i-Hollow cylindrical implants
ii-Full cylindrical implants
Successful results in the short term, BUT
unacceptable results in long-term (38% in 10 years)

11. 5-Screw shaped(threaded) implant
• The most common used implant.
• The shape of implants parallel or tapered .
• The majority of all implants have parallel walls, BUT
recently TAPERED implants are preferred ,y???
It requires less space in the
apical region + min. apical
bone fenestration +easily
placed in extraction space
Threaded implant is
preferred as it
engages bone well +
good primary
stabilization

12. • It covers almost the crestal ridge with 4 -6 posts, that passed
through the G. tissues.
• Used for overdenture or cemented fixed prostheses for an
edentulous jaw
• Used in atrophic mandible but high rate of failure
• Disadv: rapid jaw bone resorption resulting in lack of
adaption
B. Subperiosteal framelike
implants

13. - Used for retain denture in the ed. Lower jaw esp. atrophic
one.
1-Staple-bone implant…..a splint adapted to the mand., fixed
by stabilizing pins. 2 transmandibular screws were driven
transgingivally.
Survival rate more than 90% (more than 15 y)
2-Bosker model implant….has 2 metal splints
(one below the mandible and one intraorally)
to connect the 4 posts piercing ST.
• The Bosker implant <<less used<< the
Staple-bone implant.
C.Transmandibular implants

14. II-Implant Surface Characteristics
(Microdesign)
Nowadays, implant surf. are treated with
microscale & nanoscale technologies
To modify its characteristics (idea of being rough)
to influence healing + bone formation.
Additive
Processes
Subtractive
Processes

15. • Adding materials or chemicals to the implant surf.:
Ti plasma spraying, HA bio-coating with GF & fluoride
highly textured surface
Additive Processes
↑surf. Roughness  surface area of bone
surrounding the implant initial stability
accelerate the initial bone cells adaptation &
proliferation faster healing + strong bone-implant
interface.
The addition coating materials
Ca phosphate
Ti oxide
BUT HA-CaP is more osteoinductive & less corrosion

16.  Implant surface modified by removing or altering surface.
The roughness of implant surf. modified by machining,
acid etching, blasting.
Initial clot stabilization & osteoblast migration to the
implant surf. Osseointegration implant success .
Subtractive Processes
Acid etched implant was shown to have increased bone formation around implant surface

17. Hard and soft tissue interface

18. Primary goal of implant
installation
Osseointegration
is a direct structural & functional
connection between bone & the
surface of implant without
intervening S.T.
OSSEO INTEGRATION
(stable bone to implant
connection)

19. bone healing and ossointegration :
• After implant insertion  Bone wounding infl.
Reaction bone resorption activation of GF &
attraction of osteoprogenator cells  differentiate to
osteoblast & fibroblasts fibro cartilagenous callus
bone callus  bone formation
• Primary stability….achieved at the time of implant surgery.
depends on the implant geometry (macrodesign)+ the Q & Q of
available bone.
• Secondary stability….achieved over time with healing.
depends on  the implant surface (microdesign) + the Q & Q of
adjacent bone.

20. • IMMOBILITY OF THE IMPLANT IS ESSENTIAL
when micro-movements at the interface >150 μm Impair diff. of
osteoblasts  form fibrous scar around implant
SO Excessive forces should be avoided (occ. loading) during
the early healing period.
Profuse irrigation with intermittent moderate speed drilling is
essential during implant osteotomy.
Otherwise, overheating or crushing  necrosis scar formation.
N.B Critical temp. for cell bone is 470c at an exposure time of 1min.

21. 1- Implant Surf. Free Energy(physical prop.)
Adv:?????
Disadv of increasing the microroughness:
 corrosion ✚ adherence of macrophages+ 
production of PGE2  bone resorption  peri-implantitis
Implant surface effect on bone
A hydrophilic wet implant  adhesion
energy initial healing  Implant stability
2- Micro-Roughness(micro-topographic prop.)
3-Implant Surface Chemical Composition
Implants made of carbon or hydroxyapatite resistance to occ.
Forces fracture.
Today, majority of implants are made of Ti corrosion resistant.

22. Epithelium
The apical part of the G. sulcus is lined with long JE.
Connective Tissue
no PDL & cementum
Peri- implant = natural dentition
BUT
Keratinized Tissue
• Implants surrounded by non k. mucosa more periimplant
problems. y???
are limited due to the lack of PDL  high risk of infl.
Blood supply

24. PRETREATMENT EVALUATION
Medical
History?
Chief
Complaint
Dental
History?
Intraoral
examination

25. Intra oral examination
Overall dental
and periodontal
health
Implant site
Hard tissue
evaluation
Soft tissues
evaluation
MD & BL dimensions of ed. spaces
Anatomic vital structures, defects & variations
Quantity and quality of bone Quantity and quality of ST
K. mucosa around implant
MG. concerns
OH-pathological
lesion-occlusion

26. • Examine the MD & BL dimensions of ed. spaces
• Note any orientation or tilt of adj. teeth and their
roots . Otherwise , ortho. Rx may be
indicated.(coronal part and apical part)
• Using diagnostic models & imaging tech. to
determine :
1. Whether ADEQUATE space is available ?
2. Whether ADEQUATE bone volume exists to replace the
missing teeth?
1-Asses overall dental & PD health –OH- H & S
tissues(any pathological lesions)-occlusion –jaw
relation.
2-Evaluation of implant site

27. A-Hard Tissue Evaluation:
1. Visual examination
2. Palpation….anatomic defects & variations(ex:
concavities and undercuts.
3. With LA….. probe through the ST(intraoral bone
mapping) to:
-Assess the thickness of the ST.
-Measure the bone dimensions.
4. Evaluation the relationship of bone in 3D view…To
determine bone quantity

28. Evaluation of available space
Min. width(BL) of alv. Bone needed=6-7mm
Ant.Min height >10mm while in post.mand+12mm, y??
MD =??
Interdental space
Interocclusal spaces
Alveolar bone dimensions
Res. stack

29. Think ???
B. plate 0.5-1 mm
Li plate 1mm
Maxillary sinus 1mm
Nasal cavity 1mm
Inf. Alv. canal 2mm
Mental nerve 5mm from foramen

30. Radiographic Examination
including:
2. Periapical radiographs
1. Panoramic projections
3. Tomographic cross-
sectional imaging
• Identification of vital structures??
• Assessment of the quantity, quality of bone
• Whether the bone is adequate for the implant placement in proper
esthetic & functional relationship with the adj. & opposing teeth.

31. B-Soft Tissue Evaluation
• Evaluation of the quality, quantity, and location of ST.
• Any MG. concerns, ex: frenum attachments or pulls.
• Evaluation of K. mucosa around implant. Y??
It forms a strong seal around the implant with a cuff of circular
(parallel) fibers that resists mastication forces & easily OH
procedures & esthetics.(otherwise ST augmentation)

32. Risk
factors
Medical and Systemic
Health-Related Issues
Habits and Behavioral
Considerations
Psychologic and
Mental Conditions
Intraoral
examination
findings

33. Medical and Systemic Health-Related Issues
• Diabetes Mellitus:
Poorly controlled patients….impaired healing+ liability to infection
+change in bact. Microflora ….risk of failure.
• Bone Metabolic Disease:
Osteoporosis is a skeletal condition of decreased mineral density
Primary osteoporosis
• Menopausal changes (type I)
• Age-related changes (type II)
• Idiopathic causes (type III)
Secondary osteoporosis related to different diseases & conditions(ex:
diabetes, alcoholism, malnutrition, and smoking).
Success rate is high in dense bone >>poor quality loose trabecular one

34. Immune Compromise and Immune Suppression
• Pat. with an immunocompromising dis.( HIV- AIDS) or
undergoing chemotherapy or taking medications that
impair healing potential (e.g., steroids)
Radiation Therapy
• Osteoradionecrosis (ORN), a serious condition of non-healing
exposure and infection of bone.
• If necessary, surgical procedures can be done with hyperbaric
oxygen (HBO) therapy to reduce the risk of ORN

35. Medications
-Steroids used for hormone displacement, cancer treatment
,or immune suppression……suppress the immunity +impair
healing .
Bisphosphonate-related osteonecrosis of the jaw (BRONJ): is
exposure/necrosis of the bone in pat. exposed to bisphosphonates
(More than 8 weeks and no history of radiation therapy)
include: extractions, PD surgery, RCT, and implant surgery
-Bisphosphonate
Primary used in cancer (IV)& osteoporosis (oral)
N.B
Any surgical procedures, should be avoided to patients under IV
bisphosphonate therapy or oral bisphosphonate > 3 y.

37. Habits and Behavioral Considerations
Smoking and Tobacco:
• Affect white blood cells, vasoconstriction, wound healing, and
osteoporosis.
Parafunctional Habits: clenching or grinding (consciously or
unconsciously),increase rate of implant failure:
1. Failure to integrate
2. Loss of integration
3. Implant fracture
Solution … narrow occ. table + flat cusp angles & the regular use
of occlusal guards
Substance Abuse: irresponsibility & noncompliance
Some patients are malnourished or have impaired organ function.

38. Psychologic and Mental Conditions
• Uncooperative
• Lack of understanding
• Behavioral problems
• 1- Atrophic maxilla
• 2- Current infection(endodontic)
• 3- PD diseases
Intraoral examination findings

39. Thank you