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Dental implantology lec 1 2013

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Dental implantology lec 1 2013

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Dental implantology course has multiple spechialisms incorporated into
it, mainly prosthodontic part and there are radiological and periodontal
and surgical parts.
Radiology part is concerned about bone volume and texture and CT
scan, while surgical part is concerned with bone grafting in severe cases.
Dr.Saleh al shannaq will be the course coordinator, it is 2 hours credit
course, it is purely theoretical, 1 credit hour every semester.
Because more than one instructor will cover this course, every instructor
will be responsible of the reference of his lec. Anyway Dr.saleh
recommended "cotemporary implant dentistry as a suitable book for
us.
For other information see the syllabus
.
History of dental implant:
Many of us think that implant is something new, but it seems that it has
an old history!
Maya civilization which is in south America worked with
endosseous implant 1350 yr. before per-ingvar branemark
(implant inventor) work with titanium.

Archeologists excavated Maya burial sites Honduras in 1931 and
found fragments of mandible of Maya origin and they thought
that she is a female, dating from about 600 AD. They found three
shells in a tooth shape in anterior mandible were osseointegrated
with the compact bone that means this female has these shells in
her mandible before her death, because no way of
osseointegration after death !!!

Dental implantology lec 1 2013

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1950s research at Cambridge University in England: titanium
chamber was embedded in the soft tissue of the ears of rabbits.
1952 Swedish orthopedic surgeon per-ingvar branemark: titanium
chambers in rabbit femurs, after several months he was unable to
remove them that mean there is osseointegration between them.

1965: branemark placed the first dental implant into a human
volunteer, and he made a surprise that his pts. Used prosthesis
supported by implant in anterior mandible 15 yrs. ago without
telling anybody.
Implant is documented in the worldwide in 1977 and started to be
one of the options.
- NOTE: anterior mandible is one of the best locations for dental
implants because it has such good compact bone.
So if you notice this wonderful history which is started from a shell and
ends by titanium !!

Why titanium is the best material of choice?
Titanium is a natural cheap base metal in which very minimal oxide layer
composed above it, to get strong osseointegration there are two
features: presence of oxide layer, have minimal thick layer in which
titanium has minimal thick oxide layer so it has best osseointegration .
..

Why are dental students so interested in dental implantology?
Because they think that it has the highest esthetic being achieved, and
because of its financial concern as part of money-driven dentistry.
But the idea of having best aesthetic just by implant is not completely
true, because in some cases implant gives the worst aesthetic.
So implant increases the options of treatment of missing teeth either
than prosthodontic treatment like RPD,FPD.
Dental implantology lec 1 2013

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In cases of kidney implant or retinal implant, kidneys or retina are
translated into living individual from another person , it's not the same
case in teeth implant although it named "implant" y3ny teeth are not
translated from person to person , it's not the same case !!


Implant is not analogous to tooth, isn't a living tissue, is not a root it's a
device made of alloplastic material ( inert material that does not react
with the body tissues) and usually it's titanium beneath the mucosal
and/or periosteal layer and on/or within the bone to provide retention
and support for a fixed or removable dental prosthesis.
Nowadays, studies are being achieved to use zirconia and fiber-induced
material as material for implants.
Implant is not final fixed prosthesis so it could be fixed over implant,
removable over implant, fixed-removable over implant.


Implant is also called "fixture" y3ny some thing fixed in place. And it
could be cylindrical or screw ( ) and it could solid or hollow ( y3ny
have holes inside it in which bone is entered).
Definition of dental implant
Here this pic .illustrates the main
differences between a natural tooth
and an implant with crown.
In which natural tooth has a root,
PDL, crown.
While implant does not have PDL, it
has ankylosed titanium screw in the
bone.
Dental implantology lec 1 2013

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Is implant contraindicated in grower pts.? And why?
Yes, it's contraindicated in grower pts. Who are below 20 yrs.
Especially males according to their late growth spurt compared to
females.
So if it's done to grower pt. teeth will continue to erupt as growth
continues so the surrounding teeth will erupt while the implant is
ankylosed and that means it will not move , so for example after 3
yrs. The surrounding teeth will be higher in occlusion compared to
it and it looks like submerged tooth.
Like in pediatric cases in which infra-occluded tooth without PDL
so it will not supraerupt.


Teeth in implant are slightly out of occlusion when they are
opposed to natural teeth.( why)?
Because while the pt is squeezing teeth opposed each other the
implant will be higher in the occlusion compared to natural tooth.
, because natural tooth can be depressed in socket 120
micrometer while the implant can't because of ankylosis.
So implant teeth have to be slightly out of gentle bite.




Endosteal: titanium pieces are inserted in the bone after
oseotomy .. it could be screws or cylinders or in some cases
plates or blades when having thin bone.
An example of threaded solid screw
NOTE
Types of dental implant
Dental implantology lec 1 2013

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The most commonly used is screws either cylindrical or
threaded tapered having macro-threads or micro and
macro-threads and the least commonly are plates or
blades.
subperiosteal: y3ny elevating a flap and putting titanium piece
like plate subperiosteal then bone will be formed over this
piece.
They are not common such as endosteal because of their
high failure rate; even in cases of bone loss we do bone
grafting.
The most commonly marketing is screw and cylinders either
macro-threaded or micro and macro-threaded and micro-
threaded tapered or parallel.




Different lengths and different diameters, for example previously they
used to use 20-22 mm in lengths but nowadays it's just 5-6mm and
maximum to 13 mm.
That means the longer the implant NOT the better it is.
In general implant diameter has to be accommodated with the size of
restored tooth, but it is not a rule!!
So the design is the most important factor, what makes Petra a piece of
stone the second wonder in the world?
It's just the design !!
Y3ny piece of titanium by just having special design will be rescuer to pt
lost teeth after an accident and makes him again naturally looking!!
Here are examples
of parallel, parallel
and tapered, tapered
body.
Dental implantology lec 1 2013

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The failure of implant is much worse than failure of conventional
prosthesis.




Firstly dental implant just used in pts with missed teeth either one
tooth or all teeth.
What ere the treatment options for replacing upper and lower
edentulous pt. ?
Complete denture.. implant supported prosthesis

What are the treatment options for replacing missing tooth?
- No treatment (in case of missing wisdom tooth, for example).
- Removable partial denture.
- Bridge (fixed partial denture) by all its kinds: conventional,
fixed-fixed, movable-fixed and cantilever.
- Implant supported prosthesis (removable, fixed) according to
remaining bone, lip support, many other factors.
- Combination y3ny more than one option, implant with RPD ,
implant with FPD, implant with nothing!
.




After putting an implant into the bone, what are the kinds of restoration
that is put over the implant?
- Direct to fixture or Direct to implant: simply the restoration is
connected to the implant by screw.
It's used when the operator fixed the implant correctly to the bone in
the proper position without any wrong deviation so simply its final
restoration, restoration screw and implant!
Treatment options
Restoration of an implant
Dental implantology lec 1 2013

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- Angulated or not proper exit point of implant in which we can't put
the final screw directly over it so we use an abutment.

In such case we use firstly restoration with accessory screw or
occlusal screw and also named transverse screw or lateral crew
or horizontal screw or cross-pin screw or without screw as in
Jordan we just cement it, then this screw over an abutment
and the abutment over prosthetic screw over an implant.













Prefabricated
aesthetic abutment
for correction of
malpositioned
implant.
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Okay let's discuss cases in slides :

In case of proper position of dental implant into the bone the final
restoration will be just one piece without an abutment so called
direct to fixture .

In cases of posterior teeth implant we can use ceramic onlay ,gold
onlay and implant crown, then we cover the screw opening in the
crown by composite , and after a period of time composite will be
stained.

In cases of improper position of implant we use a restoration with an
abutment.

Note: the number of implants are not always the same as the number
of restored teeth because as we said simply the implant is not a
tooth!.

In case of missing lateral and premolars, implant tooth is
cemented over an abutment and they will be out of occlusion in
lateral excursion.

Selected pictures for abutments, I hope that they are clear!
Dental implantology lec 1 2013

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Case of pt. had an accident and lost two central incisor, lateral and
canine in which three implants are placed direct to fixture except
one of them which needs an abutment.
In a case of missing lower anterior area from canine to canine,
implant is done although there is bone resorption.

Implant dentistry develops and used the computer which scanned
the pt mouth and screen the bone in 3-D view, and the operator
select the location of implants according to surgical guides, then
the implant frame came ready according to operator guidance and
without elevating any flaps the implants are inserted.

And there is a margin of error by 1 mm, because the operator may
not correctly position the implant into the bone or because of not
elevation flap and just insertion over soft tissue which could be
flabby!
So operator can use abutment in case of malpositiond implant or the
design needs abutment!
In case of denture over implant , denture will be click on the locators
on the mouth instead of depending on saliva and cohesion .


-
Done By : Mays Jaradat.
1 2
3
Pic 1: pre-treatment of lower
edentulous ridge.
Pic 2: titanium implant and titanium
bar.
Pic 3: these are plastic clips imbedded
into denture attached to the bar.