Dental Implants

Copyright 2005 by Elsevier Inc. All rights reserved.

Right now my life is just one learning experience after another By the end of the week I should be a genius!
Jeanette Osias

Implant Guidelines
History (endosseous)
dates to Egyptians Greenfield (1913) patented two-stage system

Formiggini (1947) father of modern implantology helical wire spiral

IMPLANT

Copyright 2005 by Elsevier Inc. All rights reserved.

IMPLANT
Educational Implant Video Implant Surgery Lateral Insicor

Lets watch few videos now Dental Implants DVD for Patients Dental implant surgery training video Dental implants course video part 2 Implant phases Demonstration of ScrewPlant Surgical and Prosthetic Procedures

Copyright 2005 by Elsevier Inc. All rights reserved.

Lets watch few videos now

Oral Surgery & Dental Implants Implant 1st surgery Sinus Lift

3D Medical Animation of a Dental Implant

Surgery of Dental Implant (Animation) dental implant educational video
Copyright 2005 by Elsevier Inc. All rights reserved.

Dental Implants
Artificial teeth are anchored to surgically

embedded tissue or bone. This specialty incorporates principles from both fixed and removable prosthodontics in conjunction with the use of bone-anchored implants.

Indications for Dental Implants

Increase the support, stability, and patient satisfaction for a full lower denture

restoring an edentulous atrophic mandible

restoring a single missing tooth Increase the patient's comfort in chewing Increase the patient's confidence in smiling and speaking

Increase the patient's overall psychological health

Esthetics Provide support for a partial denture

Restoring Atrophic Edentulous Mandible

Restoring Atrophic Edentulous Mandible (cont'd)

Restoring a Single Missing Tooth

Restoring a Single Missing Tooth (cont'd)

Two single endosseous units were placed for tooth #18 and tooth #19.

Contraindication for Dental Implants

The financial investment is greater Treatment can take up to 9 months Risk of infection and other complications An implant may loosen and require replacement Implant procedure may be challenging for some patients Bruxism is a significant component of failed implants Patients with certain medical complications

Contraindication for Dental Implants

unrealistic patient expectations alcohol/drug dependence (smoking) parafunctional habits psychological factors anatomical factors inadequate ridge/interarch dimensions Immunosuppression inadequate bone at implant site excessive bony concavities inadequate vertical space for implant

ramus graft

sinus lift or IAN transposition

Implant Advantages
no preparation of tooth/adjacent teeth bone stabilization & maintenance retrievability improvement of function psychological improvement

Implant Disadvantages
risk of screw loosening risk of fixture failure length of treatment time need for multiple surgeries challenging esthetics

Preliminary Evaluations for Implants

Psychological Evaluation
Dentist assesses the patient's attitude, ability to cooperate during complex procedures, and overall outlook on dental treatment

Dental Evaluation
Dentist evaluates the condition of the teeth, soft tissues, areas of attached and unattached tissue, and the height and width of the edentulous alveolar bone ridge

Preliminary Evaluations for Implants-contd

Medical Evaluation
Assess any existing medical conditions that could worsen as a result of the stress of implant surgery

Radiographs
Panoramic, cephalometric radiographs, and tomograms are needed to evaluate the height, width, and quality of bone

Preliminary impressions
Surgical stent

Assisting in an Endosteal Implant Surgery

Copyright 2005 by Elsevier Inc. All rights reserved.

Materials Used for Dental Implants Biomaterials

most commonly used
commercially pure (CP) titanium titanium-aluminum-vanadium alloy (Ti-6Al-4V) - stronger & used
w/ smaller diameter implants

Materials Used for Dental Implants Titanium

lightweight biocompatible corrosion resistant
(dynamic inert oxide layer)

strong & low-priced

Materials Used for Dental Implants Fixture types

HA coated Ti surface modified tap or self-tapping screw or press fit

Osseointegration of Dental Implants

The process by which the living jawbone naturally grows around the implanted dental supports.

Copyright 2005 by Elsevier Inc. All rights reserved.

The Interface with Bone

Osseointegration

Dynamic process Healing phase: 0 - 12 months Remodeling phase: 3 - 18 months Steady state: 18 months ---

Various Types of Dental Implants

Subperiosteal implants Transosseous or staple implants Endosseous or tooth form implants

Copyright 2005 by Elsevier Inc. All rights reserved.

Endosteal Implants
Also known as Osseointegrated Implants, are surgically placed into the bone Three components of endosteal implants

1. Titanium implant 2. Titanium abutment screw 3. Abutment post or cylinder

Components of an implant restoration

- Screw retained implant restorations consist of three components. (a) implant fixture (b) abutment (c) restoration - the abutment screw secures the abutment to the fixture

Composite resin Gutta percha Retaining screw Abutment screw Abutment

Implant fixture

- the prosthetic retention screw secures the prosthesis to the abutment.

Abutment
(Screw retained restoration) Abutment screw (green) - can be either parallel Abutment (standard) or conical (red) (estheticone) in shape. - are secured with an abutment screw that is tightened to 20 Ncm.

Abutment
(Cemented restoration) - Cera One abutment - secured with a square head screw tightened to 32 Ncm.

Prosthetic retaining screw

Retaining screw - can have a slot or hex head - access is usually covered by a combination of gutta percha and composite. - used to retain the prosthesis to the abutment. - tightened to 10 Ncm.

Hand Screw Drivers

Prosthetic retention slot screw driver

Prosthetic retention hex screw driver

Hex Abutment driver

Standard and conical (estheticone)

Square abutment driver

Cera One or square abutment screws

Placement of Endosseous Dental Implants (cont'd)

Placement of Endosseous Dental Implants (cont'd)

Placement of Endosseous Dental Implants

Two-stage implant placement procedures Single-stage implant placement procedures Prosthodontic phase

Procedure Process of an Endosteal Implant

First Surgery
Implant fixture placed in receptor sites in the jawbone at predetermined locations Mucosa is sutured over the fixtures A period of 3 to 6 months is required to permit the fixture to osseointegrate or bond to the bone

Procedure Process of an Endosteal Implant-contd

Second Surgery
Implant fixture is exposed and the abutment screw is connected to the anchor Implant protrudes through the mucosa and connects the fixture to the prosthesis Patient begins the restorative phase

Subperiosteal Implants
This type of implant places a metal frame under the periosteum but on top of the bone.

Example of subperiosteal implant

Procedure Process of a Subperiosteal Implant

First Surgery
Alveolar ridge is exposed and impressions taken Tissue is repositioned over the ridge and sutured back into place Impression sent to laboratory where metal frame with posts is fabricated

Procedure Process of a Subperiosteal Implant-contd

Second Surgery
Alveolar ridge is surgically exposed Metal frame is placed over the ridge With frame in place, the tissues are repositioned and sutured into place

Transosteal Implants
Primarily used on patients with severely resorbed ridges. The implant is inserted through the inferior border of the mandible and into the edentulous area.

Preoperative Guidelines

Consent form should advise:

Background information on implants Complications of implant surgery Prognosis Time frame Home care Follow-up appointments

Maintenance of Dental Implants

Home Care Devices

Toothbrushes (manual or electric) Single-tufted toothbrushes Partial denture clasp brushes Interproximal brushes Dental implant floss Floss

Recall Appointments

Patients should be scheduled at regular intervals for:

Examinations Radiographs Prophylaxis Removal of fixed components Replacement of components Relines and remakes as recommended

Diagnosis begins with a complete patient evaluation

two-stage surgery
(use of clear acrylic surgical stent is mandatory!)

stage I - implant fixture placement w/ cover screw (left submerged)

3 month minimum (mandible ) usually 6 months for posterior regions 6 month minimum (maxilla) - usually 6-9 months for all regions

Diagnosis begins with a complete patient evaluation

stage II - uncovering & placement of transmucosal healing abutment healing phase
4-6 weeks for soft tissue healing

Implant Guidelines
Treatment
Problem list & treatment considerations surgical analysis surgical guide stent - *one of the

planning phase

most critical factors for obtaining an ideal surgical & esthetic result used during fixture installation as guide for optimal B/L and M/D position use of buccal channel drill guide allows improved access & visibility

Super - Floss
- Excellent for all types of implant restorations

Butler Post Care Floss Aid - Excellent for implant bars and fixed hybrid prostheses.

Fixed Hybrid Prosthesis - Hygiene care with a proxy brush

Implant supported fixed partial denture

Scaler tips are designed to fit the curvature of the standard abutment.

Plastic probes are used when checking for evidence of disease.

Implants are similar to the natural tooth. Implantitis vs. Periodontal disease have similar clinical presentations