education

1. DENTAL IMPLANTS
Presented by : Vikram Singh Pundir
Guided by: Dr Deepak Grover
Presented to : Dr Viniti Goel (Professor and Head)
Dr Deepak Grover (Professor)
Dr. Deepak Bala (Reader)
Dr. Tanvi Ohri (Sr.Lecturer)
Shikha and Jaspreet (3rd year)
Sarvani (2nd year)
Sonam and Malti (1st year)

2. DENTAL IMPLANT

3. CONTENT
1.Defination
2.Parts of Dental Implants
3.Various implant systems
4.Concepts of Osseointegration
5.Surgical Technique
6.Latest advances in implantology
7.Conclusion
8.Refrences

6. DENTAL IMPLANT
A Prosthetic device of alloplastic material(s)
implanted into the oral tissues beneath the
mucosal &/or periosteal layer &/or within the
bone to provide retention & support for a fixed
or removable prosthesis

7. RATIONAL OF IMPLANTS
• Maintenance of bone
• Maintenance of occlusal vertical dimension
• Esthetics
• Proper occlusion
• Improved patient psychological health
• Regained propioception
• Increased retention and stability
• Improved phonetics
• Improved success rates of prosthesis

8. PARTS OF A MODERN DENTAL
IMPLANT…
I-Implant PFZ-Post Cylinder PFS-Abutment Screw

9. Basic Parts of Dental Implant
• Sealing Screw
• Healing cap
• Laboratory Analogue

10. VARIOUS IMPLANT SYSTEMS
These differ mainly in biomaterial design
and surgical procedure.
3 implants design are:
• Screw shaped
• Cylinder shaped
• Tapered screw shaped

11. VARIOUS IMPLANT SYSTEMS
• NOBEL Biocare/Branemark
• International Team for Oral Implantology(ITOI)
• 3i (Implant Innovations)
• Astra Dental Implant System
• IMZ
• Osstem
• Indident (Indigenous) & many more

12. Implant Bone Interface
THEORIES
OSSEOINTEGRATION
BRANEMARK(1985)
FIBROSSEOUS INTEGRATION
LINKOW(1970)
JAMES(1975)
WEISS(1986)

13. CONCEPT OF
OSSEOINTEGRATION
Successful Implant Restoration depends
on……….
stable implant-bone interface

14. According To Material Groups
OSBORNE & NEWSELEY
DISTANT
OSTEOGENESIS
CONTACT
OSTEOGENESIS
Osteoconduction
Osteoinduction

15. Osseointegration
• As first described by
Brånemark denotes at
least some direct
contact of living bone
with surface of
implants at light
microscopic level.
• Without interposition
of non-bone tissue.
• Direct structural &
functional connection.
OSSEOINTEGRATION
OSSEOINTEGRATION

16. Mechanism of Osseointegration
Blood (b/w Fixture & Bone)
Blood Clot
PMNL PHAGOCYTES
PROCALLUS
CALLUS
BONE
Remodelling

17. Osseointegrated Implant
(Cross Section)

18. Osseointegration
• The concept also named ‘Functional Ankylosis’
by Shroeder
• Also called Osteo-integration as
Osseointegration considered a trademark of
Brånemark & manufacturers NobelPharma

19. Histological Aspects of
Osseointegration
• Electron Microscopy contradicts direct
implant-bone contact.Amorphous cell free
layer of glycosaminoglycans-or lamina
limitans like line-50nm wide &
mineralization 2um from metal.
• However a rigid Fixation or functional
Osseointegration is present.

20. FIBRO-OSSEOUS INTEGRATION
• Tissue to implant contact by interposition
of a healthy dense collagenous tissue
between the implant and the bone
interface.
• Normally, fibro osseous union between
the implant surface and adjoining alveolar
bone is not desirable because union
formed is a week union.

21. • The formation of fibro osseous integration
is attributed to proliferation of connective
tissue into the interface, which hampers
the osseous integration process.

22. EVALUATION OF IMPLANT
STABILITY
NON INVASIVE METHODS
• Percussion
• Radiographs
• Periotest
• Resonance Frequency analysis(Meredith et al)
• Implatest
• Dyanamic Model Testing
• Reverse removal test
• GCF Evaluation-Presence of (AST)
• Synchrotron Radiation imaging
• High resolution Micro focus X-Ray

23. Osseointegration-radiographs

24. PERIOTEST DEVICE

25. Invasive Methods
• GRINDING using L.M. Tech (Donath
et al)
Enables 10mm thick section at interface
• HISTOMORHOMETRY-fr. Ground
section
• ULTRASTRUCTURAL STUDIES-TEM

26. CRITERIA FOR IMPLANT
SUCCESS
• Immobile when tested clinically
• No peri-implant radiolucency on radiograph
• Vertical bone loss less than 0.2mm annually
• Absence of pain, infections, neuropathies

27. KEY FACTORS FOR
OSSEOINTEGRATION
ALBREKTSSON(1981)
• Implant Material
• Implant Design
• Surface Quality
• Status of Bone
• Surgical Technique
• Loading Condition
HOBO(1988)
• Biocompatibility
Material
• Design of Fixture
• Prevention of excessive
heat
• Loading Consideration

28. IMPLANT Materials
TITANIUM - most suitable
• Excellent Biocompatibility
• Non-reactive
• Formation of oxide on surface
• Strong & Malleable
• Favours osteoconduction

29. Implant (Fixture) Designs
Various Classifications based on design:
• According to Anchorage Components
• According to Geometry
• Dyanamic Dental Implant
Classification(A.F.N.O.R)-1998
• According to Diameter

30. According to Anchorage Components…
1.Eposteal/Subperiosteal
2.Endosteal
3.Transosteal

31. Subperiosteal Implants
These Implants are
placed beneath the
periosteum of the
bone

32. Interdental Subperiosteal Implants

33. Subperiosteal
PROSTHETIC
OPTIONS
SUITABLE ARCH
BONE REQUIRED
1.OVER DENTURES
2 .F.P.D.
MAX./MAND.
COMPLETE/PARTIAL
> THAN 5MM IF LESS THEN
AUGMENTATION OF INF. BORDER OF
MANDIBLE/SINUS ELEVATION
SUITABLE ARCH

34. Endosteal
• A Device placed into the alveolar &/or
basal bone of mandible or maxilla &
transecting only one cortical plate

35. Types Of Endosteal Implants
Root Form
Crete Mince
Mini Implants
Transitional
Blade Implant
Ramus Blade
Ramus frame

36. 1. Press Fit
2. Self tapping
3. Pretapping
Threaded Non Threaded
ROOT FORM

37. Endosteal

38. Blade Implants

39. Ramus Blade & Ramus frame
A three blade one piece device designed
for a relatively atrophied mandible

40. Transosteal
It is a one piece Transmandibular complex
implant penetrating both cortical plates &
passing through the full thickness of Alveolar
bone

41. Endodontic Stabilizer
An implant placed through the apex of tooth
to increase the root length

42. Endodontic Stabilizer
Endodontic Stabilizers &
Instruments
Bone ingrowth in successful
stabilizer

43. Endodontic Stabilizer

44. Intramucosal Insert
These are button like devices used to stabilize
Maxillary or mandibular complete or partial
dentures

45. According to Geometry…
• Threaded Screw
• Press-Fit Cylinder
• Hollow Basket Cylinder

46. Dyanamic Dental Implant
Classification(A.F.N.O.R)-1998
• Axially Inserted dental implants
crestal approach
• Laterally inserted Dental implants
basal approach

47. According to diameter…
• Regular platform 4.5-4.8mm
• Wide Platform 5-5.5mm
• Narrow Platform 3.3-3.75mm

48. Etched titanium,Hydroxyapatite & titanium
plasma spray Surface treatments
Surface Quality

49. Surgical Technique
Prerequisites for Osseointegration
• Minimum trauma during surgery
• Rotation of cutting instrument less than 800
rpm
• Cooling with physiologic saline
• Establishment of Primary stability
• Avoidance of infection
• Bio-inert implant material
• Healing period of at least 3 months

50. Surgical Technique
Prerequisites for Osseointegration
• Minimum trauma during surgery
• Rotation of cutting instrument less than 800
rpm
• Cooling with physiologic saline
• Establishment of Primary stability
• Avoidance of infection
• Bio-inert implant material
• Healing period of at least 3 months

51. • Diagnostic wax Up
• Sectioned duplicate
cast of Wax-up
• Saggital bone outline
drawn using bone
mapping procedure

52. • Determination of
mucosal thickness
• Sectioned cast with
bone outline
• Saw-cut cast with
hollow cylinder
implant

53. SURGICAL PROCEDURE

54. Stage 1 Implant surgery
1. partially edentulous
ridge
2. mesial & distal
incisions connected
by a supracrestal
incision

55. 3.Minimal Flap
elevation
4.Buccal flap partially
dissected at apical
portion

56. 4. Drilling using a
surgical template
5. Guide pins placed to
ensure proper
alignment

57. Sequence for drilling for Implant Insertion

58. 6.Cover screws after
Implant placement
7.suturing completed

59. Stage II Implant Surgery
1. 3-4 months
(Mandible) & 4-5
months (Maxilla)
later..
2. Vertical incisions
connected by a
supracrestal incision

60. 3.Buccal partial
thickness flap-
suture to periosteum
4.Exposure of cover
screws using
gingivectomy
technique

61. 5. Abutment screwed
onto endosteal
implants
6. Implants with Fixed
prosthesis

62. • Loss of upper
incisors
• Surgical Template in
place

64. Overload Consideration
Strategies to avoid implant Overload
• Place implants perpendicular to occlusal
plane
• Place implants in curvilinear manner
• Avoid use of Cantilevers
• Control Occlusal factors(cusp
angles,width of occlusal table)

65. CLINICAL CONSIDERATIONS
• Indications
• Contraindications
• Advanced Surgeries

66. Indications
• Distal Extension case
• Severely atrophied residual ridge
• Insufficient number of teeth
• Unfavourable position of teeth
• Single tooth replacement
• Orthopedic anchor

67. Edentulous Mandible
Bilateral Distal
Extension
Single Tooth
Replacement

68. Supporting Pier
abutment
Unilateral Distal
Extension

69. Main Indications For Implants

70. Contraindications
• Compromised health
• Diseases of mucous membrane & jaws
• Smokers
• Psychologically unstable
• Chronic alcoholics
• Parafunctional habits
• Poor Oral Hygiene

71. Advanced Surgeries & Bone Grafting

73. Sinus Lift procedure

74. Autogenous Bone Graft Placed

75. Site Ready For Implant …

76. MAINTENANCE THERAPY
SET OF SOLID TITANIUM CURRETTES FOR
PROFESSIONAL IMPLANT MAINTAINENCE

77. Calculus around Implants…

78. Scaling of Implants…..
REMOVAL OF CALCULUS WITH A GRAPHITE CURRETTE

79. COMPLICATIONS
BIOLOGIC
-Periimplant mucositis
-Periimplantitis
TECHNICAL FAILURES
-Abutment loosening/fractures
-Esthetic Complications

80. Peri-implantitis ……
Initial therapy
Anti-infective
Surgical therapy
Tt of bony defects
Resective Therapy
Regenerative Therapy

81. OTHER APPLICATIONS
• Implants in growing children
• Implants in Orthodontics

82. Implants for Growing Patients
• Used when there is congenital partial anodontia or
traumatic bone loss
• Conservation of bone is most important reason
• Minimum age is 18-20years.
• Favoured sites-mandible midline
• Implants in max. Post. Quad. Delayed till 15yrs in
females & 17yrs in males.

83. Implants In Orthodontics

84. • Implants as source of absolute
anchorage- Onplant
- Aarhus Implant
- Mini Implant
• Anchorage & abutments
• Implant site preparation
improved by orthodontics

85. LATEST ADVANCES IN IMPLANTOLOGY
“ALWAYS CONSULT A PERIODONTIST BEFORE
PLANNING A IMPLANT”
• Digital Implantology (2-D to 3-D)
• Basal Implantology
• Immediate Loading implants
• Immediate Insertion Implants
• Flapless design in Implants

86. REHABILITATION
WITH IMPLANTS
KNOWLEDGE
TRAINING
EXPERIENCE
CLINICAL & TECHNICAL SKILLS
ATTITUDE
CONCLUSION

87. References
• Contemporary Oral and Maxillofacial
Surgery 5th edition
• Jan Lindhe Clinical periodontology and
implant dentistry 5th edition
• Carl E Mish implant dentistry