IMPLANT

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

 DENTAL IMPLANT
A prosthetic device made of alloplastic material
implanted into the oral tissues beneath the
mucosal and within the bone to provide retention
and support for a fixed or removable prosthesis
Implant v/s Natural tooth
 OSSEOINTEGRATION
◦ An apparent direct connection of an
implant surface and host bone without
intervening connective tissue
◦ Thus there is a direct structural and
functional connection between the bone
and implant to transmit functional
stresses directly to the bone
 FIBRO – OSSEOINTEGRATION
◦ The presence of a layer of intervening
fibrous connective tissue between a
dental implant and the adjacent bone is
indicative of failed osseointegration
◦ There is a fibro-osseous ligament
formed between the implant and the
bone and this ligament can be
considered as the equivalent of the
periodontal ligament
◦ There is presence of collagen fibres at
the bone-implant interface
 In 1952, Professor Per-Ingvar Branemark, a
Swedish surgeon, while conducting research into
the healing patterns of bone tissue, accidentally
discovered that when pure titanium comes into
direct contact with the living bone tissue, the
two literally grow together to form a permanent
biological adhesion
 He named this phenomenon "osseointegration"
 The material must be made of pure titanium
 Precision should fit into the bone
 Excess heat generation should be avoided
 Implant loading is avoided during healing period
1. Completely edentulous patient with advanced
residual ridge resorbtion.
2. Poor retention of denture due to anatomic
factors
3. Poor oral muscle coordination
4. Active or hyperactive gag reflex
5. Parafunctional habits
6. Unfavourable location of tooth to be replaced
7. Single tooth loss
8. Long span fixed partial denture
9. Psychological inability to wear dentures
10. Low tolrance of mucosal tissue
 Irradiated patient
 Psychiatric patient
 Blood disorder
 Presence of pathologies
 Drug and alcohol abuse
 Pregnancy
 Improper motivation
 Lack of experience
 Unrealistic expectations
 Acute illness
 The success of a dental implant relates directly to
accuracy of method to maximize amount of bone
tissue contact
 In osseointegration there are 4 factors necessary
to achieve a successful osseointegrated bone to
implant interface:
◦ Biocompatible material
◦ Profile fit
◦ Atraumatic surgery
◦ Proper healing phase
 Biocompatible material
◦ Material should be biocompatible

 Profile fit
◦ Size of gap between implant and bone
immediately after implant placement is
critical for achieving osseointegration
◦ The precise instrumentation and a
technical sound surgical procedure to
minimize distance between implant
and bone
Atraumatic surgery
To allow:
a) Minimal mechanical and thermal injury
Use sharp, high quality bur at low speed by high toque
drill
b) Copious irrigation
Keep bone temprature to level below 56 degrees (which is
at level beyond which irreversible bone damage occur)

If gap between implant and bone can be minimised and

surgery is atraumatic embryonic bone will rapidly be laid
down between implant and bone which will mature into
lamellar load bearing bone
 Proper healing phase
◦ First month critical for initial healing,
when load is applied to implant during
initial healing period
◦ During this period embryonic bone is
converted into mature bone
◦ Implant should be left undisturbed in the
bone for sufficient period of time
◦ Implant mobility during this phase is also
affected by bone quality and quantity
◦ Area of jaw that have a high percentage of
cortical bone anchors the implant
successfully(anterior mandible)
◦ It is important to leave atleast 2mm bone
between apical end of implant and inferior
alveolar canal
 SITE FOR IMPLANT PLACEMENT MINIMUM INTEGRATION TIME

Anterior mandible 3 months

Posterior mandible 4 months

Anterior maxilla 6 months

Posterior maxilla 6 months

Into bone graft 6-9 months

 STRUCTURE MINIMUM REQUIRED DISTANCE
Buccal plate 0.5mm
Lingual plate 1 mm
Maxillary sinus 1 mm
Nasal cavity 1 mm
Incisive canal Avoid midline
Interimplant distance 3mm b/w outer edge of implant

Inferior alveolar canal 2mm from superior aspect of canal

Mental nerve 5mm from ant. margin of bony

foramen
Inferior border of mandible 1 mm
Adjacent natural teeth 0.5 mm
 National institute of health given following criteria:
NIH CRITERIA (1978)
 Mobility of less than 1mm in any direction
 Bone loss not greater than ½ of vertical height
of implant
 Gingival inflammation amenable to treatment
 To be considered successful, implant should
provide function service of 5 yrs
 NIH CRITERIA (1989)
 Individual unattached implant should be
immobile when tested clinically
 No evidence of peri-implant radiolucency
present as assessed on an undistorted
radiograph
 Mean vertical bone loss is less than 0.2mm
annually after first year of service
 No persistent pain, discomfort, infection
attributed to implant
 Implant design does not preclude
placement of crown or prosthesis with
appearance that is satisfactory to patient
and dentist
1. DEPENDING ON ANATOMICAL SITE
I. Subperiosteal
II. Transosteal
a) Mandibular staple
b) Transmandibular implant
III. Endosteal
a) Plate/Blade form
b) Root form
 Threaded
a)Screws - e.g. ventplant, sterioss
b)Cylindrical screws - e.g. branemark
 Non threaded
a)Bullet shaped
b)Basket form
IV. Mucosal inserts
V. Ramus frame
VI. Endodontic

2. DEPENDING ON THE REACTIVITY WITH BONE

a) Bioactive e.g. ceramic and
hydroxyapatite
b) Bioinert e.g. titanium,carbon,vitallium

3.DEPENDING ON THE TYPE OF INTEGRATION

a) Fibrointegrated
b) Osseointegrated
4. DEPENDING ON THE MATERIAL USED
a) Metallic implants e.g. titanium,cobalt,
chromium,molybdenum
b) Non metallic implants e.g. ceramic, carbon,polymer

 According to bone density clinical condition is

grouped into:
◦ Type I
◦ Type II
◦ Type III
 It consists of a cast metal framework that is
placed beneath the periosteum and overlying the
bone

PROCEDURE
An over compressed impression is made from
which two surgical impression trays and a
surgical bite registration tray are prepared
 Procedure is divided into 5 phases:
◦ Phase I – stage I surgery
 A crestal incision is made and bone is
exposed
 Direct bone impression is made and
centric relation is recorded

◦ Phase II – lab fabrication of frame

 It consists of major connectors,
secondary struts and 4 abutment
heads
 It is made of titanium or vitallium
◦ Phase III – stage II surgery
 It is done after 1 week
 Mucoperiosteal flap is reflected and
implant is inserted

◦ Phase IV – temporary prosthesis

 An acrylic posterior bite block and
anterior six teeth are placed

◦ Phase V – final prosthesis

 Placed soon after healing is completed
 It is an implant that penetrates full thickness of
the bone.

◦ Types:
1.Mandibular staple
2.Transmandibular implant
 Mandibular staple
◦ It consists of metal plate with retentive
pins that holds it against inferior border
of mandible and transosteal pins that
penetrate full thickness of ridge crest

 Transmandibular implant
◦ It is a symphyseal device made of gold
alloy
◦ It is fixed to jaw by five cortical screws
and it is fixed on four threaded posts
◦ For using this mandibular height should
be 9 mm
◦ Major advantage is that each post can be
removed individually if it fails
 These are mushroom shaped titanium projections
that protrude from the tissue surface of denture
 It is mainly indicated in maxilla
 Denture is anchored by means of these
projections
 It is important to insert the implant entirely within
the mucosal tissue
 It has a flat blade like portion having vents
 Blade comes in a variety of shapes and sizes
 The denture is constructed on posts, which
project from the blade into the oral cavity
 There are variety of blade designs and
techniques available
 They are long pin like implants which are
inserted through the root canals of teeth into
the bone of the peripheral region
 They are used to stabilize mobile teeth
 The usefulness of teeth with short roots but
otherwise healthy can be extended for few
more years through the use of these implants
Two concepts of endosteal tissue reaction have
been proposed:

1.Osseointegration by Branemark
2.Fibro-osseous integration by Weiss
1.IMPLANT BODY OR FIXTURE
◦ It is placed within the bone during first stage of
surgery
◦ It could be threded or non-threded.
2.HEALING SCREW
◦ During the healing phase,this screw is placed in
superior surface of body
3. HEALING CAPS
◦ They are dome-shaped screws placed over the healing
screw after the second stage of surgery and before
insertion of the prosthesis
◦ They range in length from 2-10mm
 4. ABUTMENTS
◦ It is a part of the implant, which
resembles a prepared tooth,and is
designed to be screwed into the implant
body
◦ It provides retention to the prosthesis
5. IMPRESSION POSTS
◦ It is a small stem that facilitates the of
the intra oral location to a similar
position on the cast
6. LABORATORY ANALOGUES
◦ These are machined structures, which
represent the body of implant
◦ It is fixed over the impression post
7. WAXING SLEEVES
◦ It is fixed to the laboratory analogue
during the fabrication of super
structure
8. PROSTESIS RETAINING SCREWS
◦ It penetrates the fixed restoration and
secures it to the abutment

TYPES OF IMPLANT SUPER-STRUCTRES

These are the prosthetic components fabricated
over implant after its placement, such as:
 Implant supported overdentures
 Implant supported fixed partial denture
 Implant supported fixed detachable bridges
 Implant supported single tooth replacements
This includes medical,dental and diagnostic evaluation.
 MEDICAL EVALUATION
◦ Patient is evaluated if he is fit for surgical procedure
◦ Medically compromised patients are not indicated for
surgical or implant therapy
 DENTAL EVALUATION
◦ Bone is evaluated at the preferred implant site.
◦ Bone is classified into four types based on its density:
 Dense compact bone
 Porous compact bone
 Coarse trabecular bone
 Fine trabecular bone
 DIAGNOSTIC EVALUATION
◦ It involves radiographic evaluation of
bone
1.Periaical radiograph
2.Occlusal radiograph
3.Lateral cephalometric radiograph
4.Panoramic radiograph
5.Computed tomography
6.Measurement of mucosal thickness
 ROOT FORM ENDOSTEAL IMPLANTS
◦ Adequate amount of bone is primary
requisite for these implant
◦ A minimum of 8mm vertical, 5.25mm
mediolateral and 6.5mm buccolingual
bone is must
◦ It is available in press-fit and self-
tapping forms
 BLADE FORM ENDOSTEAL IMPLANTS
◦ It is indicated when width of bone is not
adequate for root form
◦ It requires minimum of 8mm vertical
bone height and 3mm bone width

 RAMUS BLADE IMPLANTS

◦ Indicated for atrophied mandibular
ridges
 PREOPERATIVE MEASURES
1. Surgical site is anaesthetised with or without
conscious sedation
2. Sedatives like benzodiazepines can be given
3. Perioral skin should be wiped with antiseptic like
betadine
4. Preoperative antibiotics can be given
SURGICAL PROCEDURE
◦ It includes three steps:
1. Preparation of the surgical models
2. Preparation of the surgical stents
3. Surgical placement of implant

 Preparation of surgical models

◦ The diagnostic casts should be mounted
on semi-adjustable articulators so that
the condylar movements can be
reproduced and other inter-arch factors
can be analysed
 Preparation of surgical stent
◦ A surgical stent is an appliance used to apply
pressure to soft tissues to facilitate healing and
prevent cicatrization or collapse
 Surgical placement of implant
◦ It is placed by giving either crestal, extended crestal
or arcuate vestibular incision
◦ Special drills are available in implant kit to drill the
space for the implant.After implant placement flap is
sutured to cover the fixture
◦ After 4-6 weeks site is re-opened to expose the
fixture
◦ Final impression is made using rubber base
impression material
◦ Healing caps are placed and soft tissues are allowed
to heal
◦ After removal of healing caps abutment screw is
fixed to implant body
 They are done to reduce postoperative swelling
and pain
 Edentulous patient should be asked to bite on
saline soaked gauge
 Ice packs and cold compression should be used
 Analgesics should be administered
 Chlorhexidine mouthwash should be used
 They can be of two types:
◦ Fully bone anchored
◦ Partial bone anchored
 The denture may be attached to implant by
means of
◦ Screws
◦ Cements
◦ Precision attachments
◦ Bar and clip mechanism
◦ Magnets.
 Failure due to systemic factors

 Failure due to surgical complications

 Failure in implant-prosthetic component

 Failure due to poor patient compliance