Introduction to Dental implants / dental courses

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INTRODUCTION TOINTRODUCTION TO
IMPLANTOLOGYIMPLANTOLOGY
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com
www.indiandentalacademy.comwww.indiandentalacademy.com

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TERMINOLOGY:-TERMINOLOGY:-
• IMPLANT:-Any object or material, such asIMPLANT:-Any object or material, such as
an alloplastic substance or other tissue,an alloplastic substance or other tissue,
which partially or completely inserted orwhich partially or completely inserted or
grafted into body for therapeutic,grafted into body for therapeutic,
diagnostic, prosthetic or experimentaldiagnostic, prosthetic or experimental
purposes.purposes.

33
• DENTAL IMPLANT:-A prosthetic device orDENTAL IMPLANT:-A prosthetic device or
alloplastic material implanted into oralalloplastic material implanted into oral
tissues beneath the mucosal or periostealtissues beneath the mucosal or periosteal
tissues, and onor with in the bone totissues, and onor with in the bone to
provide retention and support for fixed orprovide retention and support for fixed or
removal prosthesis.removal prosthesis.

44
• IMPANT ABUTMENT:-The portion of dentalIMPANT ABUTMENT:-The portion of dental
implant that serves to support andor retainimplant that serves to support andor retain
any prosthesis.any prosthesis.

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• IMPLANT BODY:-The portion of theIMPLANT BODY:-The portion of the
implant that provides support for theimplant that provides support for the
abutments, through adaptation uponabutments, through adaptation upon
within in or through the bone.within in or through the bone.

66
• ENDOSTEAL IMPLANT:-ENDOSTEAL IMPLANT:-
• A device placed into the alveolar and/orA device placed into the alveolar and/or
basal bone of mandible or maxilla andbasal bone of mandible or maxilla and
transecting only one cortical plate.transecting only one cortical plate.

77
• TRANSOSTEALTRANSOSTEAL
IMPLANT:-IMPLANT:-
• A dental implant thatA dental implant that
penetrates both corticalpenetrates both cortical
plates and passesplates and passes
through the full thicknessthrough the full thickness
of alveolar bone.of alveolar bone.
• They are also called asThey are also called as
staple bone implant,staple bone implant,
mandibular staplemandibular staple
implant, trans mandibularimplant, trans mandibular
implantimplant

88
• SUBPERIOSTEALSUBPERIOSTEAL
DENTAL IMPLANT:-DENTAL IMPLANT:-
• A cast metal frameA cast metal frame
work that fits on thework that fits on the
residual ridge beneathresidual ridge beneath
the periosteum andthe periosteum and
provide support for aprovide support for a
dental prosthesis bydental prosthesis by
means of posts ormeans of posts or
other mechanismsother mechanisms
protruding through theprotruding through the
mucosa.mucosa.

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• OSSEOINTEGRATION:-OSSEOINTEGRATION:-
• The apparent direct attachment orThe apparent direct attachment or
connection of osseous tissue to an inertconnection of osseous tissue to an inert
alloplastic material without interveningalloplastic material without intervening
connective tissue.connective tissue.

1010
•The ancient era (through AD 1000).
•The medieval period (1000-1799).
•The foundational period (1800-1910)
•The premodern era (1910-1930)
•The dawn of the modern era (1935-1978)
•Contemporary oral implantology (1978 to
present)
HISTORY OF IMPLANTOLOGY

1111
The ancient era (through AD 1000)The ancient era (through AD 1000)
• the earliest recorded implant specimen is fromthe earliest recorded implant specimen is from
600A.D from the Mayan civilization in south600A.D from the Mayan civilization in south
America..America..
• Dental implant and transplant history can also beDental implant and transplant history can also be
traced in-traced in-
• Africa (Egyptians),Africa (Egyptians),
• to the Americans (Mayans, Aztecs, andto the Americans (Mayans, Aztecs, and
Incans),Incans),
• and to the Middle East.and to the Middle East.

1212
• In 1862 GAILLARDOT excavatedIn 1862 GAILLARDOT excavated
a grave site near ancient city ifa grave site near ancient city if
sidon. Here he discovered asidon. Here he discovered a
prosthodontic appliance dating toprosthodontic appliance dating to
400B.C., consisting of four natural400B.C., consisting of four natural
teeth holding between them 2teeth holding between them 2
carved ivory teethcarved ivory teeth

1313www.indiandentalacademy.comwww.indiandentalacademy.com

1414
The medieval period (1000-The medieval period (1000-
1799)1799)
• This era was dominated with the transplantationThis era was dominated with the transplantation
of teeth.of teeth.
• Abul kasim an Arab surgeon, describedAbul kasim an Arab surgeon, described
transplantation procedures .transplantation procedures .
• supported by such stalwarts as Pierre Fauchardsupported by such stalwarts as Pierre Fauchard
and John Hunter.and John Hunter.
• The fear of transfer of disease,The fear of transfer of disease, led to itsled to its
unpopularityunpopularity

1515
The foundational periodThe foundational period
(1800-1910)(1800-1910)
• beginning of Endosseous oralbeginning of Endosseous oral
implantologyimplantology
• MALLIGO –in 1809, inserted a goldMALLIGO –in 1809, inserted a gold
implant into a freshly extracted site.implant into a freshly extracted site.
• 1889-implantation of a metallic capsule by1889-implantation of a metallic capsule by
EdmundsEdmunds
• 1888-use of lead by berry1888-use of lead by berry
• 1898-R.E.payne places silver capsule in1898-R.E.payne places silver capsule in
the tooth socketthe tooth socket

1616
• In 1890, ZAMENSKI reported theIn 1890, ZAMENSKI reported the
implantation of teeth made ofimplantation of teeth made of
porcelain, gutta-percha, and rubber.porcelain, gutta-percha, and rubber.
• EDMUNDS OF NEWYORK CITY-EDMUNDS OF NEWYORK CITY-
reported on march 12,1889- to the firstreported on march 12,1889- to the first
district of dental society of that city, thedistrict of dental society of that city, the
implantation of metallic capsule in theimplantation of metallic capsule in the
space occupied by upper right firstspace occupied by upper right first
premolar.premolar.

1717
The premodern era (1910-The premodern era (1910-
1930)1930)
• R.E.Payne and E.J Greenfield,R.E.Payne and E.J Greenfield,
dominated this eradominated this era

1818
Payne’s capsule implantation
technique
extracting the root,
enlarging the socket with a trephine,
and the trial fitting of the capsule
. place grooves on both sides of the socket,
filled two thirds of the socket with rubber,
fitted a crown with a porcelain root into the capsule, and
set it with gutta-percha.

1919
Contribution of GreenfieldContribution of Greenfield
• First to document an implantationFirst to document an implantation
procedure in the scientific literatureprocedure in the scientific literature
• considered implant dentistry to be theconsidered implant dentistry to be the
“missing link”“missing link”
• emphasized the importance of sterileemphasized the importance of sterile
procedureprocedure
• concept of “Osseointegration” is discussedconcept of “Osseointegration” is discussed
• Greenfield manufactured an artificial rootGreenfield manufactured an artificial root
of 20 gauge iridoplatinum wire solderedof 20 gauge iridoplatinum wire soldered
with 24-carat gold.with 24-carat gold.

2020
• In 1903, SCHOLL of leading, PennsylvaniaIn 1903, SCHOLL of leading, Pennsylvania
, implanted a porcelain tooth with a, implanted a porcelain tooth with a
corrugated porcelain root.corrugated porcelain root.
• In1925-TOMKINS – implanted porcelainIn1925-TOMKINS – implanted porcelain
teeth.teeth.

2121
• Bioceram implants are composed ofBioceram implants are composed of
single crystalline alpha aluminum oxidesingle crystalline alpha aluminum oxide
or poly crystalline aluminum oxide.or poly crystalline aluminum oxide.
• Kyocera corporation-Japan corporationKyocera corporation-Japan corporation
makes Bioceram implants.makes Bioceram implants.
• They are composed of entirely singleThey are composed of entirely single
crystalline aluminum oxide material andcrystalline aluminum oxide material and
are designated as S&E type.are designated as S&E type.

2222
• The basic designThe basic design
between twobetween two
types are theytypes are they
are different sizeare different size
and width.and width.

2323
• In 1936- BRILL inserted rubber pins inIn 1936- BRILL inserted rubber pins in
artificial prepared socket.artificial prepared socket.
• In 1937-ADAMS, developed aIn 1937-ADAMS, developed a
submerged cylindrical implant in thesubmerged cylindrical implant in the
shape of screw.shape of screw.
• The implant had a rounded bottom,The implant had a rounded bottom,
smooth gingival collar and healingsmooth gingival collar and healing
capcap

2424
The dawn of the modern eraThe dawn of the modern era
(1935-1978)(1935-1978)
• In 1937 venable developed the castIn 1937 venable developed the cast
cobalt-chromium-molybdenum alloycobalt-chromium-molybdenum alloy
now known as vitalliumnow known as vitallium

2525
• EVOLUTIONARY DEVELOPMENT HASEVOLUTIONARY DEVELOPMENT HAS
BEEN THE INTRODUCTION OFBEEN THE INTRODUCTION OF
SUBPERIOSTEAL IMPLANTS.SUBPERIOSTEAL IMPLANTS.

2626
Subperiosteal implants:Subperiosteal implants:
• development began with Dahl’sdevelopment began with Dahl’s
1941 report and his subsequent1941 report and his subsequent
patent.patent.
• Isaiah lew is credited with theIsaiah lew is credited with the
development of direct bonedevelopment of direct bone
impressions and the two-stageimpressions and the two-stage
subperiosteal procedure.subperiosteal procedure.

2727
• SUB PEROSTEAL IMPLANT DESIGNSUB PEROSTEAL IMPLANT DESIGN
EVOLUTON INCLUDES,EVOLUTON INCLUDES,
• Weinberg unilateral subperiostealWeinberg unilateral subperiosteal
implants.implants.
• 1n 1955, LEONARD LINKOW unilateral1n 1955, LEONARD LINKOW unilateral
subperiosteal implant with lingual fingers.subperiosteal implant with lingual fingers.
• In middle of 1950s SALAGRAY AND SOLIn middle of 1950s SALAGRAY AND SOL
developed a simple subperiosteal implantdeveloped a simple subperiosteal implant
with aerated horizontal bar.with aerated horizontal bar.
• 1n 1968 WEBER presented a universal1n 1968 WEBER presented a universal
subperiosteal implant.subperiosteal implant.

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• In 1974-METANG introducedIn 1974-METANG introduced
mesiodistal bar concept.mesiodistal bar concept.
• In 1978- CRANIN developed a brookIn 1978- CRANIN developed a brook
dale continuous bar.dale continuous bar.
• In the late 1970s JAMESIn the late 1970s JAMES
recommended using a buccal surfacerecommended using a buccal surface
of both rami for support of the sub-of both rami for support of the sub-
periosteal frame work.periosteal frame work.

3030
PROCEDURE FOR THE PLACEMENT OFPROCEDURE FOR THE PLACEMENT OF
SUBPERIOSTEAL IMPLANTS:SUBPERIOSTEAL IMPLANTS:
The first subperiosteal implants wereThe first subperiosteal implants were
fabricated from overextended soft tissuefabricated from overextended soft tissue
impressions and interpretation of intra oralimpressions and interpretation of intra oral
periapical radiographs.periapical radiographs.
The casts of the soft tissue were scrapedThe casts of the soft tissue were scraped
and modified in accordance to the tissueand modified in accordance to the tissue
thickness evaluated from the radiographsthickness evaluated from the radiographs
to simulate underlying bone topography.to simulate underlying bone topography.

3131
• This technique permitted the use of onlyThis technique permitted the use of only
crestal bone to support the implant.crestal bone to support the implant.
• In surgical approach, the tissues wereIn surgical approach, the tissues were
reflected and the implant inserted.reflected and the implant inserted.
• The casting did not fit accurately to theThe casting did not fit accurately to the
residual bone, so screws were inserted toresidual bone, so screws were inserted to
fix it in place.fix it in place.
• LEW and BERMAN began taking directLEW and BERMAN began taking direct
bone impressions for the mandibularbone impressions for the mandibular
subperiosteal implants.subperiosteal implants.www.indiandentalacademy.comwww.indiandentalacademy.com

3232
• SUBPERIOSTEAL IMPLANTS WERESUBPERIOSTEAL IMPLANTS WERE
FOLLOWED BY PLATE IMPLANTS.FOLLOWED BY PLATE IMPLANTS.

3434
THE TECHNIQUE INVOLVES:-THE TECHNIQUE INVOLVES:-
• Incision should beIncision should be
made along themade along the
crest of the alveolarcrest of the alveolar
ridge.ridge.
• The incision must beThe incision must be
long enough tolong enough to
permit adequatepermit adequate
reflection of thereflection of the
tissue.tissue.

3535
• The length andThe length and
location of proposedlocation of proposed
blade placementblade placement
channel is marked onchannel is marked on
the alveolar ridge.the alveolar ridge.

3636
• After determining theAfter determining the
the placementthe placement
location, the corticallocation, the cortical
plate is penetratedplate is penetrated
with series of pilotwith series of pilot
holes 3-4mm apartholes 3-4mm apart
with 700XL fissurewith 700XL fissure
bur.bur.

4141
• The holes are then connected using theThe holes are then connected using the
same bur.same bur.
• It is some times necessary to curve theIt is some times necessary to curve the
proposed implant to accommodate to theproposed implant to accommodate to the
curvature of the jaw at the placement.curvature of the jaw at the placement.
• The channel is deepened with a freshThe channel is deepened with a fresh
700XL or 700XXL bur.700XL or 700XXL bur.
• The implant attached to the blade implantThe implant attached to the blade implant
inserter and held by the knob, isinserter and held by the knob, is
conveyed to the surgical site.conveyed to the surgical site.
• The blade component is then carefullyThe blade component is then carefully
inserted into prepared socket.inserted into prepared socket.

4242
• The blade should fit tightly into the preparedThe blade should fit tightly into the prepared
socket.socket.
• It should also be at least 2mm below theIt should also be at least 2mm below the
crest of the ridge.crest of the ridge.
• The use of tricalcium phosphate ceramicThe use of tricalcium phosphate ceramic
particle, freeze dried bone, or autogeneousparticle, freeze dried bone, or autogeneous
bone particles to fill in any large voidsbone particles to fill in any large voids
recommended.recommended.www.indiandentalacademy.comwww.indiandentalacademy.com

4545
Endosteal implants:Endosteal implants:
• strock developed truly endosteal dentalstrock developed truly endosteal dental
implants in the 1940simplants in the 1940s andand was first towas first to
present the Histologic evidence ofpresent the Histologic evidence of
OsseointegrationOsseointegration
• Formiggini, in 1947, developed the singleFormiggini, in 1947, developed the single
helix wire spiral implanthelix wire spiral implant
• Zepponi, developed a cast spiral implantZepponi, developed a cast spiral implant

4747
50s and 60s50s and 60s
• was a period of trial and errorwas a period of trial and error
• dominated by the work of linkowdominated by the work of linkow
• the linkow blade or linkow blade vent, wasthe linkow blade or linkow blade vent, was
introduced in 1967 - an implant thatintroduced in 1967 - an implant that
dominated the 1960s, 70s and early 80sdominated the 1960s, 70s and early 80s
• Founded the American academy ofFounded the American academy of
implant dentistry.implant dentistry.

4848
IN 1947- FORMIGGINI- developed the singleIN 1947- FORMIGGINI- developed the single
helix wire spiral implant made of eitherhelix wire spiral implant made of either
stainless steel or tantalum.stainless steel or tantalum.
IN MID 50S LEE- introduced the use of anIN MID 50S LEE- introduced the use of an
endosseous implant with central post andendosseous implant with central post and
circumferential extensions.circumferential extensions.
In 1959 LEW described the progress andIn 1959 LEW described the progress and
evolution of subperiosteal implants andevolution of subperiosteal implants and
further modified the frame work tofurther modified the frame work to
incorporate maximum strength andincorporate maximum strength and
minimum bulk.minimum bulk.

4949
• In 1960s SCIALOM- described theIn 1960s SCIALOM- described the
use of tripoidal endosseous pinuse of tripoidal endosseous pin
arrangement.arrangement.
• They are made up of a tantalumThey are made up of a tantalum
tripoidal pin in which three intersectingtripoidal pin in which three intersecting
pins were joined by acrylic andpins were joined by acrylic and
fashioned to support a crown.fashioned to support a crown.
• Rigid fibrous encapsulation of the pinsRigid fibrous encapsulation of the pins
occurred. However survival andoccurred. However survival and
maintaining the trifurcation limited.maintaining the trifurcation limited.

5151
• In 1960s CHERCHEVE designed aIn 1960s CHERCHEVE designed a
helical implant made of co-cr.helical implant made of co-cr.
In 1960s LINKOW introduced the bladeIn 1960s LINKOW introduced the blade
vent implant.vent implant.
In 1960s SANDHAUS developed aIn 1960s SANDHAUS developed a
crystalline bone screw-consistingcrystalline bone screw-consisting
mainly of aluminum oxide.mainly of aluminum oxide.

5252
• In late 1960s ROBERTS developed ramusIn late 1960s ROBERTS developed ramus
blade endosseous implant.blade endosseous implant.
• In early 1970s GRENOBLE introducedIn early 1970s GRENOBLE introduced
vitreous carbon implants. it was firstvitreous carbon implants. it was first
placed in the canines.placed in the canines.
• Based upon biocompatibility and efficacyBased upon biocompatibility and efficacy
studies, human clinical studies began onstudies, human clinical studies began on
the use of this implant in late1970s.the use of this implant in late1970s.

5353
Contemporary oral implantologyContemporary oral implantology
(1978 to present)(1978 to present)
• originates with the 1978 conference heldoriginates with the 1978 conference held
at Harvard .at Harvard .
• Results of about 30 years ofResults of about 30 years of
experimental research in Sweden wereexperimental research in Sweden were
finally put for peer review in 1981.finally put for peer review in 1981.
• this implant was first known asthis implant was first known as BiotesBiotes
and then as the Nobelpharma implant.and then as the Nobelpharma implant.

5454
• In early 1980s TATUM introduced theIn early 1980s TATUM introduced the
omni R implants. this is a titanium alloyomni R implants. this is a titanium alloy
root form implant.root form implant.
• In1980s DRISKELL introduced the StrykerIn1980s DRISKELL introduced the Stryker
root form endosseous implant made ofroot form endosseous implant made of
titanium alloy and hydroxyapatite coating.titanium alloy and hydroxyapatite coating.
• In the 1980s cylindrical plasma sprayIn the 1980s cylindrical plasma spray
titanium and hydroxyapatite coatedtitanium and hydroxyapatite coated
implants were introduced.implants were introduced.
• In 1985 ITI implant introduced byIn 1985 ITI implant introduced by
STRAUMANN.STRAUMANN.

5555
Classification of implants materials according toClassification of implants materials according to
the tissues into which they are embedded -the tissues into which they are embedded -
Leonard. R.RubinLeonard. R.Rubin
• Intraosseous.Intraosseous.
• SubperiostealSubperiosteal
• TransosseousTransosseous
• TranscanalTranscanal

5656
Classification of implants byClassification of implants by
Charles. A.BabbushCharles. A.Babbush
• There are five main types:There are five main types:
i.i. Mucosal insertsMucosal inserts
ii.ii. Subperiosteal implantsSubperiosteal implants
iii.iii. Endodontic implantsEndodontic implants
iv.iv. Endosseous implantsEndosseous implants
v.v. Transosteal implantsTransosteal implants

5858
Classification of implants (Classification of implants (Dennis c.Dennis c.
smith, David. f. Williams)smith, David. f. Williams)
• 1)1) BuriedBuried
• A. Metals:A. Metals:
• Magnets:Magnets:
• Endodontic stabilizers:Endodontic stabilizers:
B. Non-metalsB. Non-metals
• Recontouring procedures:Recontouring procedures:
• Maintenance efforts:Maintenance efforts:
• 2)2) Semi buriedSemi buried
• A.metalsA.metals
• B.non metals -B.non metals -

5959
DESIGN CONSIDERATIONSDESIGN CONSIDERATIONS
& PARTS OF IMPLANTS.& PARTS OF IMPLANTS.

6060
• IN THE IMPALNT BODY:-IN THE IMPALNT BODY:-
• 1.crest module:- the crest module of an1.crest module:- the crest module of an
implant is that portion designed to retainimplant is that portion designed to retain
the prosthetic component.the prosthetic component.
• It represents the transition zone fromIt represents the transition zone from
implant body design to transosteal regionimplant body design to transosteal region
of the implant at the crest of the ridge.of the implant at the crest of the ridge.

6262
Implant collar:-Implant collar:-
• Designs that incorporate a microscopicDesigns that incorporate a microscopic
component into the implant bodies bycomponent into the implant bodies by
coatings with hydroxyapatite, at thecoatings with hydroxyapatite, at the
superior aspect of the crest module.superior aspect of the crest module.
• The collar allows functional remodeling toThe collar allows functional remodeling to
occur to a more consistent region onoccur to a more consistent region on
implant.implant.
• It suggests that crestal modeling is limitedIt suggests that crestal modeling is limited
to the smooth region of the implant.to the smooth region of the implant.www.indiandentalacademy.comwww.indiandentalacademy.com

6363
COVERCOVER
SCREW:-SCREW:-
• At the time of insertion of the implant bodyAt the time of insertion of the implant body
or stage 1 surgery, a first stage cover isor stage 1 surgery, a first stage cover is
placed into the top of implant to preventplaced into the top of implant to prevent
bone, soft tissue, or debris from invadingbone, soft tissue, or debris from invading
the abutment connection area duringthe abutment connection area during
healing.healing.

6565
•
HEALING SCREW:-HEALING SCREW:-
• After a prescribed healing period sufficient toAfter a prescribed healing period sufficient to
allow a supporting interface to develop, theallow a supporting interface to develop, the
second stage may be performed to exposesecond stage may be performed to expose
the implant andor attach a transepithelialthe implant andor attach a transepithelial
portion.portion.
• This transepithelial portion is termed aThis transepithelial portion is termed a
permucosal extension because it extends thepermucosal extension because it extends the
implant above the soft tissue and results inimplant above the soft tissue and results in
development of permucosal seal around thedevelopment of permucosal seal around thewww.indiandentalacademy.comwww.indiandentalacademy.com

6767
• Abutment :- is the portion of the implantAbutment :- is the portion of the implant
that supports andor retains a prosthesisthat supports andor retains a prosthesis
or implant super structure.or implant super structure.
• Three categories of implant abutments areThree categories of implant abutments are
available.1.screw retainedavailable.1.screw retained
• 2.cement retained2.cement retained
• 3.abutment for attachment uses3.abutment for attachment uses
an attachment device to retain aan attachment device to retain a
removable prosthesis.removable prosthesis.

6868
• HYGIENE COVER SCREW:-place over theHYGIENE COVER SCREW:-place over the
abutment to prevent debris and calculus fromabutment to prevent debris and calculus from
invading the internal portion of abutmentinvading the internal portion of abutment
during prosthesis fabrication.during prosthesis fabrication.

6969
• TRANSFER COPING:-TRANSFER COPING:-
transfer coping is usedtransfer coping is used
to position an analog into position an analog in
an impression andan impression and
defined by the portiondefined by the portion
of implant it transfers toof implant it transfers to
the master cast, eitherthe master cast, either
the implant bodythe implant body
transfer coping or thetransfer coping or the
abutment transferabutment transfer
coping.coping.

7171
• IMPLANT ANALOG:-used in the fabricationIMPLANT ANALOG:-used in the fabrication
of the master cast to replicate the retentiveof the master cast to replicate the retentive
portion of the implant body or abutment.portion of the implant body or abutment.
• After the master impression is obtained, theAfter the master impression is obtained, the
corresponding analog is attached to thecorresponding analog is attached to the
transfer coping and assembly poured in thetransfer coping and assembly poured in the
die stonedie stone

7373
• PROSTHETIC COPING:-PROSTHETIC COPING:-
• Usually designed to fit the implantUsually designed to fit the implant
abutment for screw retention and serve asabutment for screw retention and serve as
connection between the implant andconnection between the implant and
prosthesis.prosthesis.

8181
DESIGN CONSIDERATIONS:-DESIGN CONSIDERATIONS:-
The macroscopic body design can be cylinder,The macroscopic body design can be cylinder,
threaded, plateaued, perforated, solid, hollowthreaded, plateaued, perforated, solid, hollow
and vented.and vented.
Their surface can be smooth, coated, nonTheir surface can be smooth, coated, non
coated, or textured.coated, or textured.
They are available in submergible or nonThey are available in submergible or non
submergible forms.submergible forms.

8282
• There are three primary basic designs ofThere are three primary basic designs of
the implant.the implant.
• 1.CYLINDER- this form of implants depend1.CYLINDER- this form of implants depend
on the coating to provide microscopicon the coating to provide microscopic
retention and/or bonding to bone and areretention and/or bonding to bone and are
usually pushed or tapped into the bone.usually pushed or tapped into the bone.
2.SCREW- This form of implants are2.SCREW- This form of implants are
Threaded into a bone site and have aThreaded into a bone site and have a
microscopic retentive elements for initialmicroscopic retentive elements for initial
bone fixation.bone fixation.

8383
• Three basic screw thread geometries areThree basic screw thread geometries are
available:-available:-
• A) V- thread.A) V- thread.
• B) Buttress thread.B) Buttress thread.
• C)Square thread design.C)Square thread design.
• 3.combination of root forms are available:-3.combination of root forms are available:-
cylinder and screw- this root form designcylinder and screw- this root form design
may also benefit from microscopicmay also benefit from microscopic
retention to bone by addition of coatings.retention to bone by addition of coatings.www.indiandentalacademy.comwww.indiandentalacademy.com

8585
• Different smaller or larger implantDifferent smaller or larger implant
diameters for use in limited anatomicdiameters for use in limited anatomic
situations or surgical complications.situations or surgical complications.
• The functional area of threaded implant isThe functional area of threaded implant is
greater cylinder implant by a minimum ofgreater cylinder implant by a minimum of
30% and may exceed 500%, depending on30% and may exceed 500%, depending on
the thread geometry.the thread geometry.
• The cylinder implant design system offerThe cylinder implant design system offer
the advantage of ease placement, even inthe advantage of ease placement, even in
difficult access locations.difficult access locations.

8686
• Cylinder implants are essentially smooth sidedCylinder implants are essentially smooth sided
and bullet shaped implants that require a bioand bullet shaped implants that require a bio
active or increased surface area coatings foractive or increased surface area coatings for
retention in the bone.retention in the bone.
• Smooth sided tapered implants allows for aSmooth sided tapered implants allows for a
component of compressive loads to deliver tocomponent of compressive loads to deliver to
the bone to implant interface.the bone to implant interface.
• The larger the taper the greater theThe larger the taper the greater the
compressive loads deliver to the implantcompressive loads deliver to the implant
interface.interface.

8787
• But unfortunately the taper cannot be moreBut unfortunately the taper cannot be more
than 30 degreesthan 30 degrees

8888
• IMPLANT WIDTH.IMPLANT WIDTH.
• Over the past five decades of endostealOver the past five decades of endosteal
implant history, implants graduallyimplant history, implants gradually
increased in the width.increased in the width.
• Branemark implant system first presentedBranemark implant system first presented
implants of 3.75mm.implants of 3.75mm.
• Dental implants reflects the scientificDental implants reflects the scientific
principle that an increase in the width ofprinciple that an increase in the width of
the implant adequately increases the areathe implant adequately increases the area
over which occlusal forces are dissipated.over which occlusal forces are dissipated.

8989
• Since most teeth are 6-12mm in width, aSince most teeth are 6-12mm in width, a
clinical desire is to have implants of similarclinical desire is to have implants of similar
size.size.
• Titanium implants are 5-10 times greaterTitanium implants are 5-10 times greater
than a natural tooth.than a natural tooth.

9090
• THREAD GEOMETRY:-THREAD GEOMETRY:-
• Functional surface area per unit length ofFunctional surface area per unit length of
implant may be modified by varying threeimplant may be modified by varying three
threaded geometry parameters.threaded geometry parameters.
• Thread pitch.Thread pitch.
• Thread shape .Thread shape .
• Thread depth.Thread depth.

9191
• Thread pitch:-defined as the distanceThread pitch:-defined as the distance
measured parallel with its axis betweenmeasured parallel with its axis between
adjacent thread forms.adjacent thread forms.
• oror
• The number of threads per unit length inThe number of threads per unit length in
the same axial plane.the same axial plane.
• The smaller the pitch, the more threads onThe smaller the pitch, the more threads on
the implant body for given unit length.the implant body for given unit length.

9393
• Therefore if force magnitude is increasedTherefore if force magnitude is increased
or bone density decreases, the threador bone density decreases, the thread
pitch may be decreased to increase to thepitch may be decreased to increase to the
functional area.functional area.
• The surgical ease of placement may beThe surgical ease of placement may be
also related to the thread number.also related to the thread number.
Fewer the threads, the easier to bone tapeFewer the threads, the easier to bone tape
or insert the implant.or insert the implant.

9494
• THREAD SHAPE:-THREAD SHAPE:-
• Thread shape is another very importantThread shape is another very important
characteristic of overall thread geometry.characteristic of overall thread geometry.
• The thread shapes in the dental implantsThe thread shapes in the dental implants
are square, v-shape, and buttress.are square, v-shape, and buttress.
In conventional engineering v-thread design isIn conventional engineering v-thread design is
called “fixture”.called “fixture”.
The buttress thread shape is optimized for theThe buttress thread shape is optimized for the
pullout loads.pullout loads.

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• The square shaped or power shapedThe square shaped or power shaped
threads provides an optimized surface areathreads provides an optimized surface area
for intrusive, compressive loadsfor intrusive, compressive loads
transmission.transmission.
• Shear force on a v-shaped thread face isShear force on a v-shaped thread face is
approximately 10 times greater than shearapproximately 10 times greater than shear
force on buttress shaped thread.force on buttress shaped thread.

9696
• THREAD DEPTH:-THREAD DEPTH:-
• The thread depth refers to the distanceThe thread depth refers to the distance
between major and minor diameter of of thebetween major and minor diameter of of the
thread.thread.
• Conventional implants provide a uniformConventional implants provide a uniform
thread depth through out the length of thethread depth through out the length of the
implant.implant.
• In some systems thread depth may varyIn some systems thread depth may vary
over the length of the implant to provideover the length of the implant to provide
increased functional areaincreased functional areawww.indiandentalacademy.comwww.indiandentalacademy.com

9898
• Specially, a reverse taper in the minorSpecially, a reverse taper in the minor
diameter of a implant can produce andiameter of a implant can produce an
increased thread depth at the top of implantincreased thread depth at the top of implant
body relative to the apex.body relative to the apex.
This unconventional design feature results inThis unconventional design feature results in
the dramatic increase functional area at thethe dramatic increase functional area at the
crest of bone where stresses are height.crest of bone where stresses are height.

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• IMPLANT LENGTH:-IMPLANT LENGTH:-
• As the length of implant increases itAs the length of implant increases it
increases the surface area.increases the surface area.
• So it is common axiom to place an implantSo it is common axiom to place an implant
as long as possible preferably into theas long as possible preferably into the
opposing cortical bone.opposing cortical bone.
• Longer implants have been suggested toLonger implants have been suggested to
provide greater stability under lateral loadingprovide greater stability under lateral loading
conditions.conditions.

101101
• Bone overheating is the major complicationBone overheating is the major complication
in placing the longer implants.in placing the longer implants.
• Attempting to engage the opposing corticalAttempting to engage the opposing cortical
plate results in the overheating of the boneplate results in the overheating of the bone
results in the failure of the implant.results in the failure of the implant.

102102
• CREST MODULE COSIDERATIONS:-CREST MODULE COSIDERATIONS:-
• The crest module of the implant body is theThe crest module of the implant body is the
transosteal region from the implant body andtransosteal region from the implant body and
characterized as a region of highlycharacterized as a region of highly
concentrated mechanical stresses.concentrated mechanical stresses.
• The crest module of an implant should beThe crest module of an implant should be
slightly larger than the outer thread diameterslightly larger than the outer thread diameter
..
• The crest module seats over the implantThe crest module seats over the implant
providing protection from ingress of theproviding protection from ingress of the
bacteria or fibrous tissue.bacteria or fibrous tissue.

103103
• The seal created by the larger crest moduleThe seal created by the larger crest module
also provides greater initial stability.also provides greater initial stability.
• The larger the crest diameter also increasesThe larger the crest diameter also increases
surface area, which contributes to thesurface area, which contributes to the
decrease of stress at the crestal regiondecrease of stress at the crestal region
compared with crest module of the smallercompared with crest module of the smaller
diameter.diameter.
• A polished collar of minimum height shouldA polished collar of minimum height should
be designed on the superior portion of thebe designed on the superior portion of the
crest module just below the prostheticcrest module just below the prosthetic
component.component.

104104
• APICAL DESIGN CONSIDERATIONS:-APICAL DESIGN CONSIDERATIONS:-
• Root form implants are circular in the crossRoot form implants are circular in the cross
section.section.
• This permits a round drill to prepare a roundThis permits a round drill to prepare a round
hole, precisely fitting the body implant.hole, precisely fitting the body implant.
• Round cross sections do not resist torsionalRound cross sections do not resist torsional
forces when abutment screws are tightenedforces when abutment screws are tightened
or when free standing, single tooth implantor when free standing, single tooth implant
receive a rotational force.receive a rotational force.
• An anti rotational feature is incorporated,An anti rotational feature is incorporated,
usually in the apical region of implant body.usually in the apical region of implant body.

105105
• The anti rotational features like a whole orThe anti rotational features like a whole or
vent being most common design.vent being most common design.
• Theoretically, the bone can grow through theTheoretically, the bone can grow through the
apical hole, and resist torsional loads appliedapical hole, and resist torsional loads applied
to the implant.to the implant.
• The apical hole region may also increase theThe apical hole region may also increase the
surface area available to transmitsurface area available to transmit
compressive loads on the bone.compressive loads on the bone.
• Another anti rotational feature of an implantAnother anti rotational feature of an implant
body may be flat sides or grooves along thebody may be flat sides or grooves along the
body or in the apical region.body or in the apical region.

107107
• The apical end ofThe apical end of
each implanteach implant
should be flatshould be flat
rather thanrather than
pointed.pointed.

108108
• SURFACE COATINGS:-SURFACE COATINGS:-
• The implant may be covered with porusThe implant may be covered with porus
coating.coating.
• Two materials most often used for thisTwo materials most often used for this
purpose.purpose.
• 1.Titanium plasma spray.1.Titanium plasma spray.
• 2.Hydroxyapatite coating.2.Hydroxyapatite coating.

109109
• The titanium plasma spray surface has beenThe titanium plasma spray surface has been
reported to increase the surface area of bonereported to increase the surface area of bone
to implant interface.to implant interface.
• It stimulate the osteogenesis.It stimulate the osteogenesis.
• The surface area has been reported to be asThe surface area has been reported to be as
great as 600% with TPS.great as 600% with TPS.
• Porus surface in the range of 150-400Porus surface in the range of 150-400
microns also increases the tensile strength ofmicrons also increases the tensile strength of
the bone to implant interface, resist shearthe bone to implant interface, resist shear
forces and improve initial fixation of theforces and improve initial fixation of the
implant.implant.

110110
• HYDROXYAPATITE COATINGS:-HYDROXYAPATITE COATINGS:-
• HA coatings have similar roughness mayHA coatings have similar roughness may
also improve functional surface area.also improve functional surface area.
• A direct bone with HA coating, and strengthA direct bone with HA coating, and strength
of HA to bone interface is greater thanof HA to bone interface is greater than
titanium bone interface.titanium bone interface.
• The space between implant and bone mayThe space between implant and bone may
effect the percentage of bone contact aftereffect the percentage of bone contact after
healing.This gap healing is enhanced by thehealing.This gap healing is enhanced by the
HA coating.HA coating.

111111
• The clinical advantages of TPS or HAThe clinical advantages of TPS or HA
coatings:-coatings:-
• Increased surface area.Increased surface area.
• Increased roughness for initial stability.Increased roughness for initial stability.
• Stronger bone to implant interface.Stronger bone to implant interface.

112112
• Additional advantages of HA over TPSAdditional advantages of HA over TPS
include:-include:-
• Faster healing bone interface.Faster healing bone interface.
• Increased gap healing between bone andIncreased gap healing between bone and
HA.HA.
• Stronger interface than TPSStronger interface than TPS
• Less corrosion of metal.Less corrosion of metal.www.indiandentalacademy.comwww.indiandentalacademy.com

113113
• DISADVANTAGES OF COATINGS:-DISADVANTAGES OF COATINGS:-
• Flaking, cracking, or scaling upon insertion.Flaking, cracking, or scaling upon insertion.
• Increased plaque retention when above bone.Increased plaque retention when above bone.
• Increased bacteria and nidus for infection.Increased bacteria and nidus for infection.
• Complication of treatment of failing implantsComplication of treatment of failing implants

114114
• These coatings are specially important whenThese coatings are specially important when
bone loss occurs.bone loss occurs.
• The decision to use a coating may be basedThe decision to use a coating may be based
more on bone density.more on bone density.
• Higher success rates have been reported whenHigher success rates have been reported when
HA coating implants have been used in softHA coating implants have been used in soft
bone.bone.
• The HA should be added to an implant bodyThe HA should be added to an implant body
with most macroscopic load bearing surfacewith most macroscopic load bearing surface
area.area. www.indiandentalacademy.comwww.indiandentalacademy.com

115115
ABUTMENTABUTMENT
CONSIDERATIONS:-CONSIDERATIONS:-
• ABUTMENT TAPER.ABUTMENT TAPER.
• ABUTMENT SURFACE AREA.ABUTMENT SURFACE AREA.
• ABUTMENT HEIGHT.ABUTMENT HEIGHT.
• ABUTMENT SURFACE ROUGHNESS.ABUTMENT SURFACE ROUGHNESS.

116116
• ABUTMENT TAPER:-ABUTMENT TAPER:-
• Retention of the taper rapidly decreases withRetention of the taper rapidly decreases with
the increase in taper.the increase in taper.
• Taper degree is sum of the both sides ofTaper degree is sum of the both sides of
preparation.preparation.
• The ideal taper was originally recommendedThe ideal taper was originally recommended
to be within 2-5 degrees of parallelism ofto be within 2-5 degrees of parallelism of
path of insertion which was also placingpath of insertion which was also placing
minimal stress concentrations on preparedminimal stress concentrations on prepared
abutments.abutments.
• Manufactured implant abutment for cementManufactured implant abutment for cement
often exhibits a total taper of 25 degrees.often exhibits a total taper of 25 degrees.

117117
• ABUTMENT SURFACE AREA:-ABUTMENT SURFACE AREA:-
• The surface area of a crown or implantThe surface area of a crown or implant
abutment influences the amount f retention.abutment influences the amount f retention.
• There is linear increase in retention as theThere is linear increase in retention as the
diameter increases, for preparations withdiameter increases, for preparations with
identical height.identical height.
• Therefore the decreased surface areaTherefore the decreased surface area
results in poorer retention than most naturalresults in poorer retention than most natural
abutments.abutments.
• In addition, cements do not adhere well toIn addition, cements do not adhere well to
titanium as they adhere to prepared dentinetitanium as they adhere to prepared dentine

118118
• So additional retention features shouldSo additional retention features should
be incorporated.be incorporated.

119119
• ABUTMENT HEIGHT:-ABUTMENT HEIGHT:-
• A tall preparation offer greater retentionA tall preparation offer greater retention
than a short abutment.than a short abutment.
• The additional height not only increasesThe additional height not only increases
the surface area but also place more axialthe surface area but also place more axial
walls under tensile stress rather shearwalls under tensile stress rather shear
stress.stress.
• Also height of preparation influences theAlso height of preparation influences the
amount of resistance.amount of resistance.

120120
• Manufactured implant abutments are oftenManufactured implant abutments are often
5,7 or 9mm in height.5,7 or 9mm in height.
• Some manufacturer supply 5mm highSome manufacturer supply 5mm high
abutment to save preparation time to theabutment to save preparation time to the
dentist.dentist.
• Anterior prosthesis often may require longerAnterior prosthesis often may require longer
implant abutments to resists the arc ofimplant abutments to resists the arc of
removal, or resist lateral force in the anteriorremoval, or resist lateral force in the anterior
regions of mouth.regions of mouth.

121121
• ABUTMENT SURFACE ROUGHNESS:-ABUTMENT SURFACE ROUGHNESS:-
• The surface roughness increases theThe surface roughness increases the
retention of a restoration of by creatingretention of a restoration of by creating
micro retentive irregularities into which themicro retentive irregularities into which the
luting agent projects.luting agent projects.
• The surface roughness retention isThe surface roughness retention is
dependent on the type of burs for thedependent on the type of burs for the
preparation along with the type andpreparation along with the type and
thickness of luting agent.thickness of luting agent.
• A coarse diamond is then used over theA coarse diamond is then used over the
surface of implant abutment to increase thesurface of implant abutment to increase the
amount and depth of microscopic scratchesamount and depth of microscopic scratches

122122
DIFFERENT TYPES OFDIFFERENT TYPES OF
ABUMENTS AVAILABLE:-ABUMENTS AVAILABLE:-

144144
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