Implant Seminar (1) Part 1

GOOD MORNING
CONTENTS:
• Introduction • Implant placement surgical
• Definition procedure
• Immediate implant placement
• Indications
protocol
• Contraindications
• Complications
• Advantages
• Maintenance.
• Disadvantages
• Classification
• Components
• Evaluation- clinical, radiographic
• Armamentarium
INTRODUCTION
DEFINITION:
According to Edward J Fredrickson:
• A prosthetic device or alloplastic material implanted into oral tissues beneath the
mucosal or periosteal tissues and/or within the bone to provide retention and
support for fixed or removable prosthesis.

INDICATIONS:
• Completely edentulous patients with residual ridge resorption.
• Partially edentulous patients where RPD may weaken the abutment teeth.
• Partially edentulous jaw with distal free end situation.
• Single missing/extracted tooth.
• In patients with maxillofacial deformities.

CONTRA INDICATIONS:
ABSOLUTE CONTRAINDICATIONS: RELATIVE CONTRAINDICATIONS:
• Myocardial infarction. • Smoking
• Pathologic conditions of the jaw. • Uncontrolled diabetes
• Atrophic jaw. • Osteoporosis
• Immunosuppression. • Poor oral hygiene
• Pregnancy. • Pathologic conditions of the jaw
• Radiation therapy in jaw region- due

to compromised vascularity.
ADVANTAGES:
• Preservation of bone
• Improved function
• Aesthetics
• Stability and support

DISADVANTAGES:
• Dental implants cannot be placed in medically compromised individual.
• Longer duration of treatment
• Need a lot of patients cooperation.
• Expensive
CLASSIFICATION:
Based on its placement

in relation to bone
Endosteal implants Subperiosteal implants Transosseous implants

Based on shape of
implant
Blade type Root form cylindrical screw type

implants implants implants implants
Based on the material used:
Cr-Co-
Mo
Hydroxy
Titanium alloys Calcium apatite
phosphate
ceramics
Tantalum
Al2O3
METALS
CERAMICS
Based on their rection with bone:
Bio active implants: stimulate bone Bioinert implants: cannot stimulate

formation- Hydroxyapatite. bone formation- metals.
PARTS OF AN IMPLANT:
IMPLANT DESIGN
DIAGNOSIS AND
TREATMENT PLANNING IN
IMPLANTS
• Laboratory evaluation
• Clinical examination
• Radiographic evaluation
Laboratory examination
• Hematological Disorders
• Viral Infections
• Cardiovascular Diseases
• Endocrine Disorders
• Bone Diseases
• Lifestyle Related Factors
Clinical examination
1. Abutment mobility
2. Pier abutment
3. Terminal splinted abutment.
4. Crown size
5. Crown-root ratio
6. Endodontic status
7. Root configuration
8. Tooth position
9. Parallelism
10.Arch position
11.Caries
12.Periodontal status.
RADIOGRAPHIC EXAMINATION
• The decision of when to image along with which imaging modality to use
depends on the integration of these factors and can be organized into three
phases
Phase I
Presurgical implant imaging
Phase II
Surgical and intraoperative
implant imaging
Phase III
Postprosthetic implant
imaging
PERIAPICAL
PANORAMIC
OCCLUSAL
CEPHALOMETRIC
TOMOGRAPHIC
COMPUTED
TOMOGRAPHY
MRI
Objectives of Pre-Prosthetic Imaging
IDENTIFY DISEASE
DETERMINE IMPLANT DETERMINE BONE

ORIENTATION QUALITY
DETERMINE
IMPORTANT DETERMINE BONE
ANATOMICAL QUANTITY
STRUCTURES
DETERMINE IMPLANT
POSITION
21
OSSEOINTEGRATION
• The apparent direct attachment or connection of osseous tissue to an inert,
alloplastic material without intervening connective tissue.
• The theory developed as a result of series of experiments carried out by Branemark
and his collegues. These Studies began on bone marrow of rabbit fibula in order to
study the nature of marrow in a living bone.
Mechanism of osseointegration
HEAMOSTASIS INFLAMMATORY PROLIFERATIVE REMODELLING
Trauma factors released Degranulation Fibroblasts

Bleeding clot TGF b Fibronectin Osteoclasts
Implant surface reactions PDGF Collagen Couplling
Thrombus at capillaries – b FGF Vironectin RANK
bioactive molecules Bradikinin Decorin Osteoprotegrin
Thrombin Histamine Proteoglycans IL; Sclerostin; PG;
ADP Complement system Macrophages – hypoxia –
PMN VEGF
PTH; Vit D; Esteadiol
Collagen
Mediators – toxic wound Pericytes Bone resorption
Fibrinogen
Platelets enviroment Angiogenetic – osteogenesis Bone formation
Macrophages Osteogenesis – BMP’s Mechanotransduction
Angiogenic GF Primary stability Osteocyte
Fibrogenic GF 1st bone
TIMP’s New bone
Implant armamentarium
Goldmann fox scissors Tissue Holding Forceps
Implant Torque Wrench

Artery Forceps
Bone Tap & counter sink kit Depth Guage Implant Driver
Paralleling Pins
Implant Placement Surgical Procedure
Flap Design
Full-thickness flap: The most common technique includes a mucoperiosteal

flap, which may involve the buccal, lingual, and crestal areas
Flapless:
 This technique does not reflect the crestal soft tissue. Instead, a core of
keratinized tissue (the size of the implant crest module diameter) is removed
over the crestal bone.
 This protocol requires no sutures around the healing abutment after implant
placement.
 The advantages of this technique include less discomfort, tenderness, and

swelling, which are usually minimal.
Generic Drilling Sequence
Step 1: Pilot Drill
With most surgical systems, a 1.5-mm or 2.0-mm surgical pilot drill is used to
initiate the osteotomy.
Pilot drills are end-cutting starter drills used to most commonly initiate an
osteotomy in the center of the ridge in a mesiodistal and buccolingual dimension.
Step 2: Position Verification
 Once the initial osteotomy is prepared, it is assessed for ideal position.
 If incorrect, the osteotomy location may be “stretched” to the proper location by a side-cutting
Lindemann bur.
 This bur makes the hole oblong toward the corrected center position. After the new position is
obtained, it should be deepened 1 to 2 mm beyond the depth of the initial osteotomy.
Step 3: Second Twist Drill
The second drill used is approximately 2.5 mm in diameter, and is an end-cutting
twist drill required for the initial osteotomy to the required depth.
The osteotomy location and angulation are reassessed at this point.

Step 4: Final Shaping Drills
 Depending on the surgical system used, most shaping drills are used to sequentially
widen the osteotomy to the matching diameter of the implant being placed.
 Depending on the diameter, multiple twist drills maybe used.
Step 5: Crest Module and Bone Tap Drills
Most implant crest modules (implant neck) are larger in diameter than the implant
body
Step 6: Implant Insertion

The implant site may then be prepared for implant insertion.
The osteotomy is lavaged with sterile saline and aspirated to remove bone debris and
stagnant blood.

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GOOD MORNING

According to Edward J Fredrickson:

support for fixed or removable prosthesis.

• Completely edentulous patients with residual ridge resorption.

• Partially edentulous jaw with distal free end situation.

• Single missing/extracted tooth.

• In patients with maxillofacial deformities.

ABSOLUTE CONTRAINDICATIONS: RELATIVE CONTRAINDICATIONS:

• Myocardial infarction. • Smoking

• Pathologic conditions of the jaw. • Uncontrolled diabetes

• Atrophic jaw. • Osteoporosis

• Immunosuppression. • Poor oral hygiene

• Pregnancy. • Pathologic conditions of the jaw

• Radiation therapy in jaw region- due

• Stability and support

• Dental implants cannot be placed in medically compromised individual.

• Longer duration of treatment

• Need a lot of patients cooperation.

Based on its placement

Endosteal implants Subperiosteal implants Transosseous implants

Blade type Root form cylindrical screw type

Bio active implants: stimulate bone Bioinert implants: cannot stimulate

DETERMINE IMPLANT DETERMINE BONE

Trauma factors released Degranulation Fibroblasts

Implant Torque Wrench

Full-thickness flap: The most common technique includes a mucoperiosteal

 The advantages of this technique include less discomfort, tenderness, and

The osteotomy location and angulation are reassessed at this point.

Step 6: Implant Insertion

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