This document discusses dental implants and the components and procedures involved in dental implant surgery. It begins by defining what a dental implant is and its uses. It then classifies implants based on placement location and material. The document discusses the different types of endosteal implants and their components like the implant body, crest module, and apex. It also covers the surgical setup, including draping, trays, instruments, handpieces, drills, guides. Impression techniques involving closed and open tray methods are briefly explained. In summary, the document provides an overview of dental implants, their classification, associated surgical components and procedures.

1. BY
DR RUHI BAJAJ
1

2.  Dental implants can be used to retain single
crowns, fixed partial dentures, full arch
bridgework and removable prostheses.
 The use of dental implants is well
established and high survival rates have been
reported.
 Implant dentistry now forms a significant
part of general dental practice and patient
awareness is steadily increasing.
2

3. 3
A prosthetic device or alloplastic material
implanted into the oral tissue beneath the
mucosal or/and periosteal layer and/ or in
the bone to provide retention and support
for the fixed and removable prosthesis.
GPT 2008
What is an Implant???

4. 4
CLASSIFICATION
I) Depending on the placement within the
tissues
• Epithelial implants
• Epiosteal / Subperiosteal implants
• Endosteal implants
• Transosteal implants

5. 5
Epithelial implants
• Implant is inserted into the oral mucosa
Disadvantages
• 1. painful healing
• 2. requirement of continual wear

6. 6
Epiosteal / Subperiosteal
Implant
• Receives primary bone
support by resting on it
• Placed directly beneath the
periosteum overliying the
bony cortex
Disadvantages :
1) Slow, predictable
rejection of the implant
2) Bone loss associated
with failure

7. 7
Transosteal Implant
• Also called as Staple Bone
Implant, Transmandibular
Implant
• Penetrates both cortical
plate and passes through
the entire thickness of the
alveolar bone
• Use restricted to anterior
area of mandible

8. 8
Endosteal Implants
Extends into basal bone for support
It transects into 1 cortical plate

9. 9
Endosteal implants
Root form implants
-Used over vertical
column of bone
Plate form implants
-used over horizonta
Column of bone
1. Cylinder
2. Screw root form
3. Combination
Ramus frame implants

10. 10
Generic implant body terminology
Implant body
ENDOSTEAL IMPLANTS
- root form designed to use vertical column of bone , similar
to root of natural tooth
3 different categories
1. cylinder implants
2. screw design implants
3. combination

11. 11
crest module ( cervical geometry )
body
apex
Implant Body Regions
3 parts
1. crest module ( cervical geometry )
2. body
3. apex

12. 12
Implant Body Regions
Body
- designed for implant bone interface
Crest module
- designed to retain the prosthetic component
- has a platform on which abutment is seated

13. 13
II) Depending on the materials used
i) METALLIC IMPLANTS
• titanium
• cobalt chromium molybdenum
alloy- Titanium aluminum
vandium
• Cobalt chromium molybdenum
• Stainless steel
• Zirconium
• Tantalum
• Gold
• Platinum

14. 14
2. NON – METALLIC IMPLANTS
- ceramics
- carbon

15. 15
Depending On Their Reaction With Bone
• Based on the ability of
implant to stimulate bone
formation
1. Bio active
• Hydroxyapatite
• Tri Calcium
Phosphate
• Calcium Phosphate
• 2. Bio inert
metals

16.  Console,motor and handpiece
 Classical surgical setup
 Starter bur ( no 4 round bur ) ( high speed is
often necessary for the mandible in
particular)
 Pilot drill ( 1.6 mm diameter by 11 mm long )
with internal irrigation system
 Osteotomy drill 24 mm long ,each with
internal irrigation ( brasseler) .all drills over
3mm in diameter should be selected in
relation to the specific system of choice
16

17.  Bur extender ,mandrel ( internal irrigation ) to
be used when adajacent teeth prevent access
to bone – denar ,imz and orthomatrix make
one that can be used for all systems)
 Paralleling pins( double ended ) ,small & large
 Depth guage
 Millimeter rule
 An implant system of choice with bone tapper
,countersink ,final sizing drills & try in
17

18.  A torque driver
 Surgical template ( guide for implant
placement)
18

19. Surgical Setup principles
 Aim to keep surgical area reasonably sterile
 Cover sterile instruments with sterile paper if
procedure is not started right away
19

20. Surgical Setup - Operatory
 Drape surgical tables with sterile towel /
paper
◦ Instrument tray table
◦ Supply tray table
◦ Implant motor table
20

21. Surgical Setup - Operatory
21

22. Surgical Setup– Instrument Tray
 Mirror (A)
 Periosteal elevator, i.e
Molt-9 (B)
 Periodontal probe (C)
 Cotton forceps (D)
 Instrument for removing
tissue tags, i.e. Scaler (E)
 Castroviejo calipers (F)
 Needle holder, i.e.
Castroviejo type(G)
 Suture scissors (H)
 Tissue forceps (I)
 Hemostat (K)
 Implant torque wrench(L)
 3 4x4 gauze (M)
 5 2x2 gauze (N)
 Topical anesthetic (O)
 Anesthetic cartridges (P)
 Anesthetic Needle (Q
 Anesthetic syringe (R)
 Round scalpel w/ 15c
blade (S)
22

23. Surgical Setup– Instrument Tray
A B C D E F G H I
K
LS
R Q P O N M
23

24. Surgical Setup –
Instrument Tray
Biohazard bag Surgical suctionWater/air syringe &
Surgical handpiece 24

25. Surgical Setup – Supply tray
 Cotton forceps (A)
 Rinn kit & 2 X-ray sensors (B)
 Mirror kit (C)
 Suture (4-0, reverse cutting needle) (D)
 2 alcohol wipes (E)
 Surgical lube & cotton tip applicator (F)
 Protective glasses for patient (G)
 Cup with ½ oz of saline (H)
 Cup with ½ oz of Chlorhexidine gluconate
mouthrinse (I)
 Photo camera wrapped with barrier membrane
25

26. Surgical Setup – Supply Tray
A B C
D
E
F
I H G
26

27. IMPLANT MOTOR TABLE (
IMPLANT KIT)
 Follow manufacturers’ guide – Usually includes
◦ Large round bur to flatten site
◦ Small round bur to mark implant site
◦ Lindeman bur for decortication ( in case of zimmer
implant system)
◦ At least 2 osteotomy drills:
 Pilot drill
 Larger sizes depending on bone density and implant
diameter
◦ Implant driver for handpiece + Torque wrench with
implant driver
◦ Hex tool
◦ Bone tap
27

28.  Contains a bur to create a hole in the cortex
 Osteotomy drills that create a bone
preparation similar to the shape of the
implant
 Bone taps that shape the cortical part of the
bone preparation to match the implant shape
28

29.  Some type of implant driver that delivers and
inserts the implant into the bone preparation
◦ Shape differs by implant system. For Zimmer
implants, they are hex tools
 A wrench that is used to torque the implant
into its final position (and a certain torque in
some implant systems)
29

30.  Most systems are now color coded to
highlight instruments used for different
implant diameters
 Most systems feature sequential use of
increasing osteotomy drills
30

31.  Sequential use of drills with increasing
diameters allow precise gradual widening of
osteotomy.
 This is important as the osteotomy must be
slightly narrower than the implant, so that the
implant can engage just enough bone for
stability, but not too much bone that would
prevent insertion of the implant at a normal
force.
31

32.  All of the electrical circuitry ,controls for
speed ,irrigant, hand piece selection ,readout
in rotation per minute ( rpm) and power are
located on the console
 Even the foot controlled rheostat plugs into
and is powered by the console .
32

33. NSK Implant Motor Console
Coolant flow
(Level 3-5)
Speed
Torque
Gear ratio
(20:1)
Coolant
Flow
Forward/
Reverse
Torque (Ncm)
Speed (rpm)
Direction
33

34. NSK Implant Motor Foot Pedal
Speed
Coolant
Flow
Forward /
Reverse
( Program )
34

35.  The motor housing cords plugs into the front
of the console and utilizes its voltage supply
 The tiny motors inside the housing are
commonly referred to as micromotor and
they are designed to run at different speed.
 The most commonly used motors for root
form implants turn at 20000 ,30000 and
40000 rpm.
35

36. 36
NSK Surgic XT Implant motor
Saline flow block
Console
Staging
Block
Handpiece
36

37. Surgical Setup – Implant Motor
 Assemble handpiece & connect to implant motor
console
 Assemble saline supply & make sure tubing is
mounted correctly in peristaltic pump
 Close tube lock to prevent spilling of saline while
motor is not used
 Mount pilot drill
 Turn on unit to verify function
 IMPORTANT:
 Some systems have disposable tubing, others don’t –
Please find out before you dispose tubing
37

38.  Handpiece is any apparatus attached to an
electrical or an air- or nitrogen-powered
motor that accepts a bur.
 There are two types of handpieces:
 contra-angle and straight ; these enable the
practitioner to increase or maintain a motor’s
speed reliably.
HANDPIECES
38

39. Surgical Setup – Surgical
Handpiece
 Assemble surgical handpiece
 Mount no. 4 round bur
 Run handpiece for at least one
minute over plastic cup to
eliminate excess oil from
handpiece
39

40.  If any of the following are noted while the motor is
in use, action must be taken:
 • The practitioner feels a loss of speed with
vibration of the handpiece head. (This can cause
gear stripping and handpiece failure.)
 • The bur wobbles or chatters during cutting. (This
causes friction to the handpiece and can burn and
injure the bone.)
40

41.  • The sound of the motor changes, or the
motor begins to growl or buzz. (This may
indicate a drop in speed and power as a
result of an internal problem in the gear
housing.)
 • The motor and handpiece begin to feel
warm and get progressively hotter over
time. (This may indicate a worn gear
assembly.)
41

42.  In such instances, the rheostat should be
used to increase motor speed, because this
may help reduce the difficulties. To prevent
these problems, the practitioner should:
 1. Make smaller increases in drill diameters
 2. Use new, sharp burs and drills at
appropriate velocities and change them often
 3. Stay within the proper handpiece power
zones
42

43. Round Bur
 Sometimes used to prepare
implant site before creating
osteotomy
 Used to create flat ridge prior to
osteotomy creation so that implant
platform is level with surrounding
bone
43

44. Pilot drill
 First rotary instrument
 Cuts bone at tip and at sides
 Used to mark osteotomy site
 Used to cut through cortex at osteotomy
 Also used to correct osteotomy location or
direction by removing bone from side of
ostetomy
 Zimmer Lindeman Bur is gold-colored
44

45. Osteotomy drills
 Creates osteotomy shaped like implant
 Mostly cuts at tip.
 Depth marks indicate implant lengths
 Drill-tip (called “Y-point”) is 0.5 mm long in addition
to indicated length (i.e. 11.5 mm = 12 mm actual
length)
45

46. Paralleling Tool ( Direction
indicator)
 Used after creating first, narrow
osteotomy.
 Shows direction of osteotomy
clinically and radiographically
 Often features hole to tie floss
through it so it is less likely to be
aspirated
 Sometimes features markings
 Simply a metal pin of the same size
than the first osteotomy drill. Think of
it as “dummy implant” to show where
implant would be
46

47. Implant Driver
 Used to deliver implant into
osteotomy site
 Two varieties with different
attachments
◦ One for use in Implant handpiece (Top)
◦ Other for use in Implant wrench
(Bottom)
 Different size of hex for different
implant platforms
◦ One for 3.7, 4.1 and 4.5 mm diameter
implants
◦ Other for 6 mm implants
47

48. Implant wrench ( zimmer)
Can be used both sides:
Arrow facing you: Inserts implant
Arrow facing tissue: Backs out implant
48

49. 49
Surgical Guide
 Place surgical guide in 70% ethanol for at
least 15 minutes prior to surgery and wash
with sterile water/saline before use
49

50.  To effectively carry out any procedure, it is
crucial to familiarise oneself with the
components involved
 The first step is to determine the implant
system used (eg Nobel Replace, Nobel
Brånemark System, AstraTech Osseospeed,
Straumann SLActive, alfa bio etc) , as this will
dictate the type of impression components
used.
50

51. Each implant system has its own set of
impression components that are designed to
fit accurately onto the fixture head of the
implant, which is machined to specific
geometry.
Irrespective of the implant system used, the
impression components and techniques are
broadly very similar.
51

52. Nobel Replace fixture heads
Brånemark fixture head
52

53.  An implant screwdriver is a critical piece of
equipment used to screw and unscrew
various components onto the fixture head.
 Depending on the implant system,
screwdrivers heads can be slotted, hexagonal,
star shaped, etc .
Screwdrivers (from left to right) with a
hexagonal head (AstraTech) and star
shaped heads (Straumann and Nobel
Biocare)
53

54. Screwdrivers are often designed to fit into a
manual or motor driven torque device, which
can be used to tighten components to a
predetermined torque .
Manual torque device
54

55.  The fixture head is usually at the level of the
alveolar bone crest, therefore, in order to
provide access to the fixture head, a
removable transmucosal component known
as a healing abutment/cap is screwed onto
the fixture head by the surgeon, either at the
time of implant placement or as a second
surgical procedure.
55

56. 56

57.  Healing abutments/caps vary in height, width
and profile.
 An appropriate healing abutment is selected
to mould the peri-implant tissues during
healing and prevent tissue overgrowth.
healing abutments
57

58.  The impression coping is the component that
fits onto the implant fixture head or an
implant abutment while making an
impression.
 There are two types of impression copings:
. one that is used with a closed tray and
retained in the mouth after the impression is
removed
. the second, used with an open custom tray,
in which the impression is removed with the
coping in situ within the impression
58

59.  Once cast, the impression copings transfer
the position of the implant fixture
head/abutment onto the working model.
closed tray impression coping open tray fixture level impression
coping
59

60. 60
IMPLANT LEVEL IMPRESSION
TECHNIQUES
 CLOSED TRAY IMPRESSION TECHNIQUE
Transfer copings connected to implants

61. 61
Impression Made

62. 62
Impression removed leaving copings behind
Coping-Implant analogue assembly
inserted into impression
Impression poured

63. 63
Pick Up/Open Tray
Transfer copings and guide pin
assembly attached to implant

64. 64
Syringe material injected around
transfer copings
Tray filled with Impression material
and impression made
Impression material allowed to polymerize

65. 65
Coping-pin-implant analogue
assembly inserted to impression
Impression poured

66. 66
abutment
Implant body
prosthesis
superstructure
Prosthetic Attachment
Abutment
portion of the implant that supports or retains a prosthesis
or implant superstructure
Superstructure
metal framework that attaches to the implant abutment
and provides either retention for removable prosthesis
or framework for fixed prosthesis

67. 67
Categories of implant abutment
based on method by which prosthesis or
superstructure is retained to the
abutment
1. Screw retention
2. cement retention
3. for attachment
• attachment device to retain a
removable prosthesis

68.  Prefabricated stock abutments are off-the-
shelf components produced in a variety of
collar heights, widths and angulations
 . These are available in titanium, gold and
ceramic and can be screwed (or press fitted
with some systems) directly to the fixture
head before impression making.
68

69.  Some standard abutments come with
individual impression copings (eg Easy
Abutment, Snappy Abutment, etc, Nobel
Biocare)
69

70.  Prefabricated abutments are relatively cheap
and they simplify impression making by
moving the restoration margin coronally
DISADVANTAGE
 . However, they come in a relatively limited
number of shapes and sizes and are
inappropriate in all circumstances, especially
when the fixture head is deeply subgingival.
70

71.  For implant retained overdentures,
prefabricated abutments with a variety of
attachment mechanisms (eg ball, magnets,
LOCATOR, etc) are available in a series of
different heights and widths, with its own
specifically designed impression coping
71

72.  Custom abutments, individualised for each
restoration, can be used where prefabricated
abutments are inadequate.
 They are often made using CAD/CAM
techniques and are available in a variety of
metals and ceramics .
72

73.  Custom abutments are generally more
expensive than prefabricated abutments.
 However, they can be designed so that the
abutment-crown junction is hidden to ensure
superior aesthetics.
73

74. Depending upon retention
 Abutment for screw retention
 Abutment for cement retention
 Abutment for attachment
Depending upon angulation
• Straight abutment
• Angled abutment
74

75. – Steri oss abutment
– Paragon abutment
– Ceraone abutment
– Ceradapt abutment
– UCLA abutment
– Noble bio care abutment
– Estheticone abutment
– Mirus cone abutment
– Noble pharma single tooth abutment
– Branemark system angulated abutment
– Astra abutment
75

76.  One-piece implants incorporate an integral
abutment.
 This abutment is usually prepared using
special burs designed to cut titanium. Care
must, however, be taken to ensure that the
implant is not overheated and the abutment
is not excessively reduced.
76

77. 77
Implant system broadly are of 2
types
Two stageOne stageimmediate
1. one piece implant system
implant body +
prosthodontic abutment
2. two piece implant system
implant system
prosthodontic abutment
Implant surgery

78. 78
Implant surgery…
Two stage surgery
1st surgery
- implant body placed below the soft tissue
after initial bone healing has occurred
2nd surgery
-soft tissue are reflected
- permucosal element or abutment is
attached
One stage surgery
1st surgery
- implant and permucosal element placed
after initial bone healing has occurred
-abutment replaces the permucosal element
without reflection of flap

79. 79Implant body
First stage cover screw
Second stage permucosal extension
or healing abutment
Abutment
A) for screw retentin
B) for cement retention
C) for attachment
Hygiene screw
Transfer coping
A) direct
B) indirect
Analog
A)implant body
B) abutment
coping
Prosthesis screw

80.  Alpha-Bio Tec specializes in developing
and producing advanced dental solutions, focusing
on the field of implants and prosthetics.
 The unique and simple system makes the
dentist's work extremely convenient and
accomplishes several major advantages:
• Wide range of products with proven clinical
biocompatibility.
• Fast and easy insertion.
• High primary stability.
• High predictability.
• High success rates, in immediate loading.
80

81. Surgical drills – internal irrigations
 The surgical drills are available in sequential
diameters and in two lengths .
 The drills are made of surgical titanium and
are to be used with internal irrigation .
 All drills are color and groove coded for easy
identification during surgery .
 Drills are groove marked for lengths
81

82. 2 mm 2.8 mm
3.2 mm 3.65 mm
4.3 mm 5.2 mm
82

83.  Surgical drills –external irrigation
 The surgical drills are available in sequential
diameters and in two lengths .
 The drills are made of stainless steel and are
to be used with external irrigation .
83

84. 2 mm 2.8 mm 3.2 mm 3.65 mm 4.3 mm 5.2 mm
84

85.  Straight drills are intended for close sinus lift
and for drilling close to anatomic structures .
Stopper
85

86. To prevent over drilling. Use HTD 1.25 for fixation
86

87.  DRILL EXTENSION - Extends drill by 17.5
mm.
 INSERTION TOOLS 2.5 mmd(ITD) ( stainless
steel )
 Used for placing threaded implants with
internal hex 2.5mm .
 Hexagonal 6.35mm or square head 4mm
87

88. 6.35mm
4 mm
2.5 mm
contraangle –motor mount insertion tool ( IT 1.25
88

89.  HEX DRIVER ( 1.25 mm) HTD ( Stainless steel)
 For all types of cover screws, healing
abutment and prosthetic pieces .
 Hexagonal 6.35mm or square head 4mm
89

90. 6.35mm 2.5mm
14.5mm
4mm
11.5 mm
contraangle –motor mount hex driver ( HT (1.25 m)
90

91. RATCHET WRENCH ( stainless steel)
for 6.35 hexagonal head
UNIVERSAL TORQUE / RATCHET ( stainless steel)
Allows the clinicians to accurately apply the recommended preload
torque for surgery and prosthetics
91

92. Parallel / depth pin ( titanium )
For accurate measurement of x ray distortion . Each step
is 1 mm.
3mm 1.9 mm
1 mm
10mm
92

93. Parallel guide
Used for precise spacing and parallel placement of implant
2.3 mm
7 mm
93

94. IDG IMPLANT DEPTH PROBE ( STAINLESS STEEL)
Its gently rounded apex simplifies depth measurements and
provides easy tactile examination of bone preparation and
sinus membrane
8mm
1011.5
13
16
94

95. Sinus lift instruments
Subantral membrane elevator
•New innovation for hydraulic sinus lift .
•reduces risks of membrane tears
•Single use , supplied sterile
95

96. OSTEOTOMES
Use for implant placement ,sinus elevation , ridge expansion and
Site preparation .
STRAIGHT OSTEOTOME
ANGLED OSTEOTOME
96

97. STOPPERS FOR DRILLS OR OSTEOTOME
•To prevent overdrilling
•Use HTD 1.25 for fixation
97

98. 98
BIBLIOGRAPHY
Carl E Misch: Contemporary Implant Dentistry
Charles M Weiss : Principles And Practice Of Implant Dentistry
Steven ,Friedrickson and Geiss: Implant Prosthodontics-Clinical and Laboratory
Procedure
Maurice J Fagan :Implant prosthodontics:
Block Kant : Endosseous Implant For Maxillofacial Reconstruction
Norman Cranin :Atlas of Oral Implantology
Michael Norton :Dental Implants- Guide for General Practitioner
 British Dental Journal Vol 201;77
 Journal Of Prosthetic Dentistry Vol 89;611
 Alfabio tech manual

99. 99
Thank You