History & intro implant/ cosmetic dentistry training

History & Introduction of
Oral Implantology
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

Introduction
• Dental implants are the fastest developing
technology in practice of dentistry today.
• All facets of the dental profession are
interested in this modern treatment style.
• Implants are used to provide attachment
anchorage of replacement artificial teeth.

• Feature of anchoring provides an alleviation of
the fears, patient has about the RPD.
• Helps to establish the esthetic and social value
of their smile line.
• As Cervantes wrote in Don Quixote, "Every
tooth is more valuable than a diamond."

Four scientific breakthroughsFour scientific breakthroughs
1. Two basic biomaterials titanium, and
aluminum oxide
2. The application of (CT) to develop jaw bone
models for sub periosteal implants.
3. The concept of osseointegration.
4. Biological or transmucosal seal of the
gingival tissues around the implant neck.www.indiandentalacademy.com

Background of ImplantsBackground of Implants
• The concept of dental implants has been around
since antiquity.
• Archeological evidence reveals that Egyptians
implanted precious stones and metals into jaw
bone where teeth were lost.
• Excavation of ancient Mayan civilization
yielded the implantation from seashells.

• For the past 100 years or more, scientific
approaches to replacement of lost teeth…
• Autogenic and allogenic, and avulsed teeth
• Patients often ending up infections.
• In modern times, implants have been utilized in
clinical practice since 1940.
• Use of implants were at times criticized by
other members of the profession…www.indiandentalacademy.com

History of Implantology
• Since the age of prehistoric man, humanity has
suffered from dental pathology and decay.
• Tooth decay & its treatment, can be traced to
the Babylonians and the God Ea (5000 B.C).
• Hesi-Ra (2600 B.C) who was recognized as the
first dental practitioner.

The Ancient Era
• The history of dental implants is as fascinating
as it is ancient.
• Intra-osseous implantation of animal teeth and
artificial teeth carved of ivory was performed
on court women of the ancient Egyptian.
• Prior to mummification, artificial or animal
teeth were implanted in the jaw to assure proper
preparation for the afterlife.

• Earliest recorded dental implant specimen was
inserted during the pre-Columbian era.
• Wilson Popenoe discovered a skull with an
artificial tooth carved from a dark stone.
• This truly artificial device, not a transplanted
natural tooth, was dating to A.D. 600.
• Radiographs showed compact bone formation
around two of the implants.www.indiandentalacademy.com

• It seems logical, then, that the Mayans
practiced the implantation of alloplastic
materials.
• Mayans also inlaid precious stones and
practiced tooth mutilation for esthetic and
superstitious reasons.
• Wooden drill bits would be hand-driven and
sand was utilized as an abrasive.
• Prior to these treatments, pt would chew coca &
ingest hallucinogenic mushrooms for anesthetic
purposes.

• Oral Implantology can also trace its history to
the Middle East dating 400 B.C.
• Discovered a prosthodontic appliance
consisting of four natural lower teeth holding
between them two carved ivory teeth, all held
together by gold wire.
• Also in this earliest historical period, tooth
transplants can be traced to the Greeks, the
Etruscans, and the Romans.

Medieval Period
• Medieval era of implant dentistry was primarily
concerned with the transplantation of teeth.
• Abul Kasim, an Arab surgeon (936-1013),
described transplantation procedures. He also
fabricated implants made from ox bone.
• In Japan during the 15th and 16th centuries,
wooden dental prostheses were designed to
function as a dowel crown.

• This is evidence of early endodontic implant
supported prosthesis.
• A prominent surgeon of the 1500s, Ambroise
Pare, emphasized the advantages of
transplantation.
• Morse, in his excellent history of implantation
procedures, gave description in 1530 as…

• During this period satirist Thomas
Rowlandson criticized the practice, as did
others.
• Human teeth were expensive and scarce and
cadaver teeth were usually repugnant to
patient.
• Implants made from ivory, shells, and bone, or
human teeth used for transplants, were not
satisfying the requirements.

• In fact, it was being reported in the 1700s that
tooth transplantation could lead to the transfer
of disease, and even death.
• Eventually the procedure diminished in
popularity in the beginning of the 19th century.

Foundational Period
• Endosseous oral implantology truly began in
the 19th century.
• Maggilio, in 1809, inserted a gold implant into
a freshly extracted tooth socket.
• As Driskell comments," this implant was not
truly submerged, but the tissues were allowed
to heal passively without a crown.

• The crown was attached only after the tissues
appeared to be healthy.
• Author of The Art of the Dentist, Maggilio also
discussed a means for affixing pivot teeth in
natural or artificial roots by means of a spring.
• In 1845 Rogers stated the usefulness of roots
for fixation of artificial teeth.

• The late 1800s saw a resurgence in procedures
using implantation of natural teeth.
• Congdon wrote that the implantation of teeth
"seems to have achieved satisfactory results,
though failures were many”.
• Documentation of implanted biomaterials in
19th century traced to Harris,& Edmunds.
• He implanted an artificial porcelain tooth crown
on a leaded root in a socket.www.indiandentalacademy.com

• Berry, in 1888, wrote concerning the need to
obtain teeth free of danger of communication
of disease.
• He suggested that possibly porcelain teeth with
roots of wood, tin, or silver would be retained
if skillfully placed.
• In 1890, a Massachusetts minister had his
lower jaw resected because of a tumor.

• Znamenski, in 1891, reported on implantation
of teeth made of porcelain, gutta-percha, and
rubber.
• At the National Dental Association meeting in
1898, R. E. Payne gave the first clinic on
implantation.
• “Implantation of a Silver Capsule”

The Premodern Era
• Two innovative clinicians, R. E. Payne and E.
J. Greenfield, dominated the first two decades
of the 20th century in oral Implantology.
• Greenfield was the first to carefully document
an original implantation procedure in the
scientific literature.
• Greenfield considered implant dentistry to be
the missing link of Dentistry.www.indiandentalacademy.com

• Sterility and cleanliness often overlooked in the
middle decades of the 20th century.
• Negligence led to negative opinions of
implantology that we are still disclaiming
today.
• Greenfield manufactured an artificial root of 20
gauge iridio-platinum wire soldered with 24-
carat gold.

• Greenfield repeatedly emphasized the imp of
the bone being intimately associated with the
implant prior to proceeding to the next stage.
• The modem era of implant dentistry most
definitely began in the late 1930s with the work
of Venable, Strock, Dahl, Gershkoff and
Goldberg.
• In 1937 Venable developed the cast cobalt-
chromium-molybdenum alloy now known as
Vitallium.

• An initial use of Venable's Vitallium was the
use of a Venable screw-type dental implant by
Alvin and Moses Strock beginning in 1939.
• Strock developed both endodontic and truly
endosteal dental implants in the 1940s.
• Subperiosteal implant development began with
Dahl's 1941 report and his subsequent patent.
• Weber presented the universal subperiosteal
implant in 1968www.indiandentalacademy.com

• Mentag introduced the mesio bar concept in
1974, Cranin developed the Brookdale
continuous bar in 1978.
• Additional endosteal implant designs were
developed rapidly in the late 1940s, 1950s, and
1960s.
• Formiggini, in 1947, developed the single helix
wire spiral implant made of either stainless
steel or tantalum.www.indiandentalacademy.com

• The period of the 1950s and 1960s was a period
of trial and error in the development of implant
designs.
• Linkow is probably best noted for development
of the blade implant, an implant that dominated
the 1960s, 1970s, and early 1980s.
• His blade vent design, known as the Linkow
blade or Linkow blade vent, was introduced in
1967. www.indiandentalacademy.com

• Linkow also motivated the development of a
professional organization of implant dentists
which in 1951 became the American Academy
of Implant Dentistry.
• During the 1970s implantology grew.
• Also at this time, Per-invar Branemark was
developing an extraordinary implant study in
Sweden (beginning in 1951).

• Kawahara was developing a ceramic implant in
Japan (beginning in 1970).
• ITI group in Switzerland was developing the
Swiss Hollow Basket implant.
• The sphere of oral implantology was indeed
expanding.
• Contemporary oral implantology originates
with the 1978 conference held at Harvard.

• titanium implant is the major contribution of
the Goteborg group led by Branemark and
Thomas Albrektsson.
• Contemporary studies document acceptable
tissue responses to dental implants.
• Implants can exist within dynamic epithelial
and osseous systems.
• Cylindrical-type implants were developed in
the United States in 1981 and 1982.www.indiandentalacademy.com

• The core vent implant, a modified basket
implant made into a two-stage implant, was
introduced by Niznick in 1982.
• Cylindrical implants similar to Nobelpharma
implant, such as the Steri-Oss, Flexiroot,
Osseodent, and the Screw-Vent/Swede-Vent
were all introduced after 1982.
• The Integral implant an implant similar in form
to the IMZ but coated with hydroxylapatite,
was introduced in 1984.

• Oral or Dental Implants have opened the door
to the 21st century in dentistry.
• They have increased the treatment possibilities
for patients and improved the functional
results of their treatment.
• Patients who had to compromise their esthetic
appearance, chewing functionality and
nutritional intake due to complete or partial
tooth loss can now be restored back.

• In our context, the Implant is referred to the
surgically placed part which goes either into/or
sits on top of the jawbone.
• We will also refer to it as the Fixture.
• The actual tooth or teeth that go on top of the
Implant are referred to as the Prosthesis.

Most common implant used in the dental
community is the Rootform Implant

Types of Oral Implants
• Dental implants vary in several aspects, such
as shape, place of anchorage, composition,
coatings.
• In general Oral Implants can be categorized
into three main groups:
– Endosseous Implants
– Subperiosteal Implants
– Transosseous Implants

• Endosseous Implants are the most frequently
used implants today.
• They could be further categorized into several
sub-categories; based on their shape, function,
surgical placement and surface treatment,

Subperiosteal Implants

• Subperiosteal Implants were already introduced
in the 1940s.
• Of all currently used devices, it is the type of
implant that has had the longest period of
clinical application.
• These implants are not anchored inside the
bone, such as Endosseous Implants, but are
instead shaped to ride on the residual bony
ridge of either the upper or lower jaw.

• They are usually not considered to be
osseointegrated implants.
• Subperiosteal Implants have been used in
completely edentulous (toothless) as well as
partially edentulous upper and lower jaws.
• However, the best results have been achieved in
treatment of the edentulous lower jaw.

Indications:

Ramus frame Implants
• Ramusframe Implants belong in the category of
endosseous implants.
• These implants are designed for the toothless
lower jaw only and are surgically inserted into
the jaw bone in three different areas:
• The part of the implant that is visible in the
mouth after the implant is placed looks similar
to that of the Subperiosteal Implant.

• Indications:
• Usually a severely resorbed, toothless lower
jaw bone, which does not offer enough bone
height to accommodate Rootform Implants as
anchoring devices.
• These implants are usually indicated when the
jaws are even resorbed to the point where
Subperiosteal Implants will not suffice
anymore.

Ramus frame Implants

Blade Implants
• However, since these are also surgically
placed into the bone we categorize them also
into the Endosseous Implant category.
• Blade Implants have a long track record, much
longer then the Rootform Implants.
• Their name is derived from their flat, blade-
like (or plate-like) portion, which is the part
that gets embedded into the bone.

Blade Implants

Indications:
• Blade implants are not used too frequently.
• In areas where residual bone ridge of the jaw is
either too thin to place conventional Root form
implants or certain vital anatomical structures.

Rootform Implants
• Since the introduction of the Osseointegration
concept and the Titanium Screw by
Branemark, these implants have become the
most popular implants in the world today.
• Rootform Implants are also categorized as
endosseous implants. These implants come in a
variety of shapes, sizes, and materials.
• Some clinicians regard them to be the Standard
of Care in Oral Implantology.www.indiandentalacademy.com

• Indications:
• These implants can be placed wherever a tooth
or several teeth are missing, when enough bone
is available to accommodate them.
• However, even if the bone volume is not
sufficient to place Rootform Implants, Bone
grafting procedures within reasonable limits
should be initiated, in order to benefit from
these implants.

Pure titanium Plasma Sprayed Surface
Rootform Implants

Cylindrical-type
Tapered, cylindrical

Transosseous Implants
Indications:
• These implants are not in use, because they
necessitate an extra oral surgical approach.
• In any case, these implants are used in
mandibles only and are secured at the lower
border of the chin via bone plates.
• The Transosseous Implants can also be
categorized into the endosseous implant
category. www.indiandentalacademy.com

Transosseous Implants

Frequently Asked Questions
1.What do dental implants offer over
conventional dental treatment?
A. Increase in bone anchored support:
B. Prevent bone resorption:
C. Maintain healthy teeth:

B. Prevent bone resorption:

2. How successful are implants?
3. Is age a deterrent to implant treatment?
4. Is Osteoporosis a deterrent to implants?
5. How many implants do I need?
6. Does it hurt to have dental implants placed?
7. What about the cost of dental implants?

Thank you
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History & intro implant/ cosmetic dentistry training

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