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SEGi University

Faculty of Dentistry
CDP 5.0/ Prosthodontics

Introduction to
Dental Implants

Year 5,
2016/2017 Dr. Omar
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Learning Objectives
At the end of this lecture, the students are
expected to:
1. Define dental implants
2. Identify and differentiate the parts of implant
3. Discuss the various indications and
contraindications of implants
4. Describe treatment planning for implant
restoration
5. Describe the clinical, lab and prosthodontic
steps in implant placement
6. Discuss the different techniques for implant
impression
7. Discuss the implant retained prosthodontic
options
Definition of Dental Implant
Endosteal implant is an alloplastic material(s)
surgically inserted into a residual bony ridge
beneath the mucosal and periosteal layer, to
provide retention and support for a fixed or
removable dental prosthesis.
Osseointegration
Brånemark (1952)
Described the relationship between titanium and
bone for which they coined the term
osseointegration as
A direct structural and functional
connection between ordered living
bone and the surface of a load
carrying implant
Indications for Implant prosthodontic
Treatment

1. When Patient desire for implant treatment


2. Systemic health status, which permits a minor
surgical procedure
3. Sufficient bone quantity to accommodate
prescribed implant dimensions
4. Patient willingness and ability to maintain oral
health status

4 types of bone quality D1 -D4


When is it contraindicated?
1. Patient’s current prosthetic experience is an adaptive one
2. Residual ridge dimensions do not accommodate preferred
implant dimensions
3. Communication with patient is not possible because of his or
her compromised cognitive skills
4. Patient has a history of substance abuse
5. Local anesthesia with a vasoconstrictor is contraindicated
6. General health conditions preclude a minor surgical
intervention
7. Immunosuppressive therapy, prolonged intake of antibiotics or
corticosteroids, or brittle metabolic disease history
Basic parts of dental implant

1. Crown
2. Abutment
3. Implant fixture

Others :…
Generic terms for implant components
Bar Retainers Retentive Anchors
Analog: used in the fabrication of the master cast to replicate
the retentive portion of the implant body or abutment
Three different surgical approaches for two-piece implant
systems:

(A) two stage (healing submerged, then uncover surgery),


(B) one stage (implant with permucosal healing, no
uncover surgery), and
(C) immediate
restoration
(restoration placed
at the time of the
surgical
placement.
Immediate
loading).
The most common implant systems has a
separate abutment and implant body, which
permits only the implant body placement during
bone healing. Followed by a second procedure
to attach the implant abutment.
Types of fixtures

• Cylindrical

• Screw shape

• combination
Abutment
A tooth, a portion of a tooth, or that portion of a dental
implant that serves to support and/or retain a
prosthesis.
It provides support for the crown (or several crowns i.e.
a bridge). It is also the interface between the crown
and the implant.

screw-retained bar or for removable prostheses


fixed prosthesis cement retention
Crowns: top part of a restoration and are the part
that we see in the mouth. They replicate the original
teeth to provide a biting surface
and aesthetic appearance. They are hand made by
the technician.

Usually made of PFM, Zirconia, or gold


Types of Implant prosthesis
Individual Abutment types
1. Ready made in many sizes, diameters and angulations
2. Custom cast by specialist manufacturers e.g. Nobel
Biocare (offsite). They are shaped (milled) by the technician
using special tools to provide a specific fit for the crown.
The prepared abutment is eventually screwed (with a torque
wrench) to the implant using its locators to
guide it into position
Multiple Implants prosthesis
Dental implants provided predictable and reliable
“root analogues” has renewed enthusiasm for the
use of the overdenture concept in edentulous
treatment
To place implant
Inter-implant papilla
may be generated
between two
implants as long as
the space between
the implants is 3mm
or more and 2mm
between implant
and adjacent natural
tooth
otherwise!!

Lack of interimplant papilla


Less than 3mm
Implant overdenture
1. Fixed

2. Removable
Fixed implant overdenture
Prosthodontic Approaches and Philosophies
Used for Implant Overdentures

A- Single Elements (unsplinted)


• Single ball abutments (stress
breaking mechanism)
• Single magnet abutments
(stress-breaking
mechanism)
• Individually cast telescopic
copings (rigid mechanism)
B- Connected Elements (splinted)
• Egg-shaped dolder bar (stress-breaking mechanism)
• Round clip bar (stress-breaking mechanism)
• U-shaped bar (rigid)
• Customized precision-milled bars (rigid)
Overdentures and mesostructure Bars

• Overdentures are the recommended


prostheses for many types of implant
systems and are relatively economical
and easy to use.

• Proper positioning of a mesostructure


bar is essential to a successful result
with overdentures, If no adequate
vertical dimension has been left for
construction of the overdenture,
implants can not be successfully used
Types of Implant Overdentures
1. SIMPLE POST RETENTION ("clip-on")
2. BAR-TYPE RETENTION
3. OPEN-PALATE DESIGN (UPPER PROSTHESIS)
SIMPLE POST RETENTION ("clip-on")
These posts (called abutments) are attached to the top of
each implant and are the most common of the
overdenture designs. There have been many types of
posts over the years including ball type, magnets, ERA®,
and most recently Locator (easy to use and maintain).
Locator attachment
Video
Indications for Ball or
Magnetic Attachments
• Recommended when implants are placed
underneath a patient’s presently worn
dentures, that is, ones that do not have to be
remade.
• For Denture-wearing problems of elderly
patients with impaired manual dexterity
• Should not be used to compensate for
unfavorable and nonparallel alignment of the
implants
BAR-TYPE RETENTION
The top of the implants are connected with a structure called a
"Bar". The Bar is positioned on the surface of the gingival tissues
and is generally few millimeters thick and wide. The size of the bar
is determined by the number of implants and shape of the jaw.
The material can be metal alloy, titanium, or zirconia.
• The Bar provides a means to retain the
overdenture. Retention may be provided by
friction, clips (metal or plastic), pins.

• The Implant-Bar generally provides very good


stability for the overdenture (better than the
post-type). Maintenance is still fairly simple
Indications for Bar Attachments

• Routinely recommended for maxillary


overdentures,
• Atrophic residual ridges in the mandible,
• Mandibles with more than two implants due
to pronounced ridge curvature.
mesostructure
OPEN-PALATE DESIGN (UPPER
PROSTHESIS)
If there enough upper jaw implants, it may be
possible to reduce some of palatal coverage of the
upper denture. This will provide improved comfort,
taste and less gagging effect.
Treatment planning for implant
SIMPLANT software

Surgical stent
SIMPLANT software
Use of CAD/CAM in dental implants

• CBCT – DICOMS
• SIMPLANT software
• Selection of system
• Section of fixtures
• Designing the prosthesis
• CAM phase (Milling of Rapid
prototyping)
Surgical Stent

• https://www.youtube.com/watch?v=huipj7xFFwY

• https://www.youtube.com/watch?v=aLVv4pRvEwY
How is surgical stent used for
placement of implant
How is implant kept and delivered
The implant fixture is sterilized and protected,
introduced to touch only the site of placement
Implant emergence profile
Impression copings
Impression techniques for implant

• Open tray (Direct) technique


• Closed tray (Indirect) technique

multiple implants that will be splinted in either


partially or fully edentulous patients, open tray
impression copings will be more accurate. It has
also been shown that splinting the impression
copings in the mouth (ie. with resin) can
improve the accuracy as well.
• In case of multiple implants but plan on restoring
them as single-units, you may choose to use closed
tray impression copings for ease of use. However, if
the implants are mal-aligned it is advisable to use
open tray impression copings since the misalignment
of the implants may lock the impression in the mouth
if closed tray impression copings are used because of
their lack of draw
• Open tray is more accurate

To understand the steps briefly See this video:


https://www.youtube.com/watch?v=RrwtE0yGIGs ……. Link in Blackboard
Direct impression
transfer coping
Direct Transfer
• Consists of two pieces
• Hollow transfer component
• Long central screw
• Less likely to be misplaced or
moved during model
fabrication
• Square coping remains in the
impression (direct transfer)
Indirect Transfer
Indirect Transfer
• Removed from implant
body and then reinserted
into the impression (indirect
transfer)
• Often has flat sides and
undercut areas to allow
reorientation in the
impression after it is
removed from the mouth
Direct & indirect
CHOICE OF AN IMPLANT SYSTEM
Many systems are available it may not matter which system is
chosen, this
is particularly the case with treatment in the anterior mandible.
choice of a system in any particular case depends on the
following:
• The aesthetic requirements
• The available bone height, width, and quality (including
whether the site has been grafted)
• Perceived restorative difficulties
• Desired surgical protocol
Brånemark system
They are designated as the Standard,
MK II, Conical Mk II, Mk III, Mk IV, and
Special Fixtures.
Length: from 7.0 mm to 18.0 mm
depending on the implant form.
Width: 3.3 mm, 3.75 mm, 4.0 mm, 5.0
mm and 5.5 mm.
The Brånemark implants are organized
according to a "platform concept."
• The Regular Platform (RP)
• The Narrow Platform (NP)
• The Wide Platform (WP)
The surgical kit and common
components
Torque wrench ratchet

Advantages:
1.It provide visual high torque assessment with
acceptable accuracy when implant placed manually
2.It offers tactile sensation for the resistance and
initial stability
Prognosis of implant treatment
option

Difficult to recommend extraction of compromised


teeth and replace by dental implant
In making decisions relative to extraction and implant
placement versus retention of compromised teeth:
1. The heavily restored tooth
2. The furcation-involved tooth
3. The periodontal-prosthesis patient
4. Difficult aesthetic cases
O’Neal and Butler (2002)
Guess the implant?
References and books to read
 Zarb, George A., Hobkirk, John., Eckert, Steven.,
& Jacob, Rhonda. (2012). Prosthodontic
Treatment for Edentulous Patients: Complete
Dentures and Implant-supported Prostheses.
Mosby Inc.
 Palmer, R. (August 14, 1999). Dental implants:
Introduction to dental implant. British Dental
Journal, 187, 3, 127-132.
 Misch, C. E. (2015). Dental implant prosthetics.
 The glossary of prosthodontic terms, J Prosthet
Dent 94(1):10–92, 2005.
 http://www.nobelbiocare.com
 http://www.thegellerdentalgroup.com/?page_i
d=591
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Questions and Answers

Thank you