History and evolution of implants /certified fixed orthodontic courses by Indian dental academy

HISTORY AND EVOLUTION OF
IMPLANTS

www.indiandentalacademy.com

HISTORY AND
EVOLUTION OF
IMPLANTS
INDIAN DENTAL ACADEMY
Leader in continuing dental education


CONTENTS







Introduction
Definitions
History and Evolution of implants can be studied as
-The ancient era
- The Medieval period
- The foundational period
- The Premodern era
- The dawn of the modern era
- Contemporary oral implantology
Summary and Conclusion
References.



INTRODUCTION




Def of Implant (GPT 8 )



Any object or material such as an alloplastic substance or
other tissue, which is partially or completely inserted or
grafted into the body for therapeutic, diagnostic, prosthetic or
experimental purposes.



Def of Implantology



Term historically conceived as the study or science of
planning and restoring dental implants.




Def of Dental Implant



A prosthetic device made of alloplastic material implanted into
the oral tissues beneath the mucosal or/ & periosteal layer
&/or within the bone to provide retention & support for a fixed
or removable dental prosthesis ;a substance that is placed into
or / & upon the jaw bone to support a fixed or removable
dental prosthesis.



Def. Of Osseointegration
The apparent direct attachment or connection of osseous
tissue to an inert, alloplastic material without intervening
connective tissue.






ANCIENT ERA - 1000 A.D




History of dentistry….3000 B.C .



HISTORY TRACED IN MIDDLE EAST



In 1862 Gaillardot discovered a prosthodontic appliance near the ancient
city of Sidon. Appliance was dating 400 B.C period .



Carved ivory tooth replacing the two missing incisors.




HISTORY TRACED IN THE EGYPTIAN
DYNASTIES



Evidences have shown the implantation of animal
teeth & artificial teeth carved of ivory .



Implantation prior to mummification.



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.




Cranin suggested that earliest recorded dental implant specimen was
inserted during the PRE COLUMBIAN ERA.



In 1931 Wilson Popenoe discovered a skull in the Ulua river valley of
Honduras , dating to the period 600 A.D .



Skull had an artificial tooth replacing lower left lateral incisor, carved of a
dark stone . Radiographs showed the evidence of compact bone around the
implant.



The Mayans practiced the implantation of alloplastic materials in living persons.




MEDIEVAL PERIOD (1000-1799 A.D)




Allotransplantation (18 -19 Century) mainly in
England & Colonial America.



Albucasis de Condue ( 936- 1013 A.D) an
Arab surgeon described the transplantation
procedures . He attempted to use ox bone to
replace missing teeth.




In Japan in the 15th & 16th C. Wooden dowel &
crown prosthesis was designed . The pin inserted into
the root canal of non vial teeth.



This was an early ENDODONTIC IMPLANT –
SUPPORTED PROSTHESIS.


•

•

Charles Allen in 1687 gave the first written work on
dentistry.
He described the replanting of tooth into the same patient.

•

Allen emphasized on transplantation of tooth using animal
tooth.

•

In European sphere transplantation became the common
practice performed by barber surgeons of the Era.

•

The tooth transplant could lead to transfer of diseases .

•

Implants made from ivory, shells & bone were used.


•

Ambroise Pare, a French physician , a surgeon to four kings
of France.

•

He replaced the missing teeth with implants made up of bone
& ivory .

•

He successfully replaced missing tooth of Princess by
transplanting.




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




THE FOUNDATION PERIOD (18001910)




The endosseous oral implantology truly began in the 19 th Century.



Maggilio in 1809 , a dentist at the university of Nancy , France, author of
the book called “THE ART OF THE DENTIST”. The first reference to
modern style implants.



He has described the implant & placement.



He 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 in
the freshly extracted socket site retained with the prongs. After the tissues
healed the crown was attached with the help of post placed into the hole
of root section of the implant.



He placed the single stage gold implant.



In mid 1800s advancement in the antiseptics & surgical
techniques , there were documentation of implanted materials.



W. J . Younger of San Francisco introduced operations in
United States. In 1893 he wrote that his operation has
successfully entered 8th year of life.




In 1886 Harris treated a Chinese patient in Grass valley ,
California . He placed the tooth root shaped platinum post
with lead coating, lasted for 27 yrs Reported in Dental
Cosmos in 1887.



In 1889 Edmunds of New York reported on March 12 ,1889
to the First District dental society of that city. He implanted
the metallic capsule.




In 1888 Berry reported about the root form implants made up
of lead.



In 1890 , a Massachusetts minister had his lower jaw
resected & was restored with an extensive system of gold
crowns soldered & joined to hinged device attached to the
remaining dentition .



Znamenski in 1891 reported on implantation made of
Porcelain, gutta-percha & rubber.



Bonwill in 1895 reported on the implantation of one or two
tubes of gold or Iridium as a support for individual teeth or
crown.



IN 1898 R. E Payne at the National Dental Association
meeting gave the first clinical demonstration by placing the
silver capsule in the extracted tooth socket.




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.



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.



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





GREENFIELD EMPHASIZED ON
The importance of intimate contact between bone & implant.
Hollow implants facilitated growth of bone into implant body &
secure it.



3 months period of unloading.



Implants failures because of infection.



His techniques were similar to present concepts of osteotomy
preparation, restoring after healing time




In 1920s Leger- Dorez developed expansible root implant, was
comparable to a concrete expansion bolt.



Smolon described the implant as a four part device with the shaft buried in
bone with the internal threads to receive a screw , fastening the neck into
the shaft. the post for attaching the prosthesis.



The historical basis for the internal screws provided for the retention of
prosthetic devices similar to today’s implants.



Tomkin’s 1925 implanted porcelain teeth.



Brill in 1936 inserted rubber pins in artificially prepared sockets.




THE DAWN OF THE MODERN ERA
1935-1978 A.D




The modern era of implant dentistry most definitely began in the late1930s
with the work of Venable, Strock , Dahl , Gershkoff & Goldberg.



Venable in 1937 developed the cast Co- Chr- Mo alloy known as
Vitallium.



In 1939 Alvin & Moses Strock used the Venable screw type implant.




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.



The components designed to flex vertically or
laterally similar to the IMZ intramobile element.




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.




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.



Marziani’s use of porcelain &
acrylic roots to support full
dentures.



In 1950 Lee’s Post design i.e
central narrow post with
extensions.




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




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.


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.




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.



Weinberg sectional
subperiosteal implant.



Lew developed modified
technique for fitting upper
implants by extending the
implant frame further to the
periphery.



Linkow developed Sub periosteal implant
consisting of three islands




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%.


ONE STAGE ENDOSTEAL PINS, SCREWS, &
CYLINDERS


The early 1960s marked the beginning of an active
developmental era in implant design.



Scialom developed a tantalum tripodal pin .



Three intersecting pins were joined by acrylic to support the
crown. Difficulty in maintaining the trifurcation limited the
comfortable survival.




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


SCREW TYPE IMPLANT


Tramonte introduced a stress resistant drive screw implant.



Meglan & Lehman reported on the expandable implants.



Lew introduced a self tapping Vitallium screw implant with conventional
threads & square post.



Muratori & Pasquallini introduced hollow cores along with the screw
threads.



The majority of these screw shaped implants were one piece & were not
submerged , did not osseointegrate .It was emphasized that the fibrous peri
implant membrane with its shock absorbing feature preferred than bone
fusing to implant.



In 1963 Dr. Linkow , American Dentist
developed first screw type of implant –
Vent Plant.



This was the first self tapping , self
threading implant . It had an open cage
like design that went into bone first , with
a few threads on solid body at the top. He
used Vitallium first latter on titanium.

BLADE IMPLANTS


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.



In 1970 Roberts & Roberts developed Ramus blade
implants .



It was to be positioned by anchoring distally
between the cortical plates in the ramus of the
mandible




RAMUS FRAME IMPLANT developed Roberts &
Roberts in 1970 .



The endosseous implant received stabilization from its
anchorage in ramus area bilaterally & in the symphyseal
region.


TRANSOSTEAL IMPLANTS


In 1975 Small introduced the transosteal mandibullar staple &
bone plate, a reconstructive device placed through a submental
incision & attached to the mandible with multiple fixation &
two transosteal screws to support a full arch prosthesis.



He presented 16 yrs evaluation,



Cranin developed single transosteal implant.







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




CONTEMPORARY ORAL
IMPLANTOLOGY 1978 to present






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




In 1976 Dr. Andre Schroeder in Switzerland reported the
bone growth into titanium plasma sprayed hollow
endosseous implants.



At the same time , Prof. Willischulte in Germany reported the
success with immediate placement of Vitreous Carbon implant
after dental extraction & invented Frialit-2 implant.




Per-Ingvar Branemark developed the two stage threaded titanium
endosseous root form implant in North America.



“ Vital microscopy”…



In 1960 at Gothenburg…



Branemark noticed that there was no inflammatory reaction to the
titanium.




He started thinking about the potential of titanium to
act as an anchorage point, so the spur for the next
experiment whether titanium can be used as a bridge
in bone healing application.



Concept of Osseo integration developed



The first clinical trail was done in 1965.



In 1971 surgical equipments.



In May 1982 Dr. George Zarb organized the
Toronto conference on osseointegration. Branemark
presented Two stage threaded root form implant
along with the 15 yrs research work & clinical trail.

BRANEMARK SYSTEM COMPONENTS


FIXTURE –



pure titanium with machined
threads .



The top of the fixture has
hexagonal design & threads ..



The apical portion tapered with
four vertical notches.



COVER SCREW- seals the
coronal potion of fixture during
the interim period.




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




ABUTMENT SCREW – insert through the
abutment & threads into the fixture to connect the
two components .



GOLD CYLINDER- made of lAu , Pl, Pd. It is
machined to fit the coronal portion of the abutment. It
becomes integral part of final prosthesis.



GOLD SCREW –inserted through the gold cylinder
& threads into the abutment screw to connect the gold
cylinder & abutment.

IMZ IMPLANT SYSTEM









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

IMZ IMPLANT SYSTEM


Kirsch developed the IMZ implant system in 1974. Since
1978 in clinical use.



Intramobile cylinder endosseous two stage osseointegrated
implant.



The polyoxymethylene & polyacetal used as IME.



Available in 3.5 to 4mm diameter and 8,10,13,15mm length.



Surface coating may be titanium plasma spray or plasma
sprayed HA coated surface.

LEDERMAN SCREW IMPLANT


In 1977 Dr. Philippe Lederman in collaboration with strauman
co. developed the Titanium plasma spraed screw type implant.



In 1989 Lederman developed the New Ledreman screw
implant Surface roughened by sand blasting & acid etching.


ITI BONE FIT IMPLANT SYSTEM





Developed by ‘International Team for Implantology’.
Three different types
Single stage & two stage.
Transgingivally placed in healing phase so second surgical
procedure for uncovering the implant is avoided.


THE HAND-TITANIUM IMPLANT SYSTEM






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




In early 1980s Tantum introduced Omni R implant A Ti root form implant with horizontal fins.



Omni S implant – for placing into bone grafted
maxillary sinus.




In 1983 EL Blasty & Kamel introduced the new endosseous
implant material i.e Poly acrylic acid reinforced with ceramic
alumina particles 0.3 microns.



The hydrophilic matrix swells in contact with aqueous
solution.



The gradual pressure on the surrounding bone stimulates
osseous activity.



Implanted in canine, premolar sites with promising results.

MINI DENTAL IMPLANT



In 1985 Victor Sendax developed MDI.
Ultra – small diameter 1.8 mm, biocompatible Ti alloy implant
screws.



Bulard added single one piece `O- ball’ design .


CORE VENT


Developed by Dr. Gerald Niznick in 1986.



Hollow basket design made of Ti alloy.



Different fixture designs Screw –Vent, Micro-Vent, Bio –Vent.


ENDOPORE


A root form dental implant
developed by Doughlas et.al in
1996 made of Ti alloy &
sintered with same alloy
producing porous surface.



Biological & clinical advantages.


STERI OSS SYSTEM


Introduced by Denar



Made up of 99.9% Ti, tapered apex thread design & the
coronal 3rd highly polished surface.



Available in 3.5 to 4mm diameter, length 12
mm,16mm,20mm,& miniseries8mm,10mm,12mm length.


NOVUM CONCEPT


Branemark developed the concept of providing a new set of
teeth for the mandible in a single day.



Clinically implicated in 1996.



Three titanium fixtures inserted , mucosa is closed & base
plate is placed over the fixtures & then the prosthesis is
placed.


ZYGOMATICUS FIXTURES


Branemark.



The long fixture can be anchored in zygoma by approaching
through the sinus .



Severely resorbed maxilla.




1984 – CT scan.



Bone augmentation techniques.



1986 Tatum reported about Sinus lift / Bone graft antroplasty.



1988 Nerve transposition



1989 Pterygoid implants .



1991 Guided tissue regeneration
using Gore-Tex or
resorbable Vicryl-Mesh used to augment narrow & shallow
ridges .



1995 Distraction osteotomies & split ridge technique.



The screw type implants fabricated by Hydroxy
appatite based composites by mixing HA with Al
oxide coated Zr oxide powder & compared with
Cp.Ti implants.



HA based composites showed better mechanical
properties & bioactivity.



(Young Min Kong et.al 2002).



Development of implants coated with Bioactive
Alumina –based composite by electrophoretic
deposition method.



Alumina is excellent biomaterial ,good
biocompatibility , highly corrosion resistance, high
wear resistance & strength.



Wollastonite has (CaO. SiO2) high apatite forming
ability deposited into the pores of foamed Alumina by
Electrophoretic deposition.

BICORTICAL SCREW IMPLANT


Self tapping type



Diameter 2.5, 3.5 ,4.5,5.5mm



Length 21 -30mm



Post extraction insertion for single
tooth replacement.


OSTEOPLATE 2000


Atrophic RAR



The conical plate with
shoulder width 1.3 mm
& base 0.9 mm.




Historically dental restorations supported by Osseointegrated
implants evolved as



Fully ed. Mandibular arch -1980



Fully ed. Maxillary arch



Short span ed. Segment -1990



Missing single tooth – 1990



1980s restorations were screw retained , 1990s cemented.


Summary










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



CONCLUSSION


REFERENCES


Block & Kent’s Endosseous Implants For Maxillofacial
Reconstruction.



Elaine Mc Clarence ’s Close to the edge.



Hubertus Spikerman’s Color atlas of Dental medicine
(Implantology).



Malvin E. Ring’s Dentistry An Illustrated History.



Sumiya Hobo’s oseointegration and occlusal rehabilitation.



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
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.


Vol

Thank you
Leader in continuing dental education


History and evolution of implants /certified fixed orthodontic courses by Indian dental academy

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