Scientific Rationale For Dental Implant Design

Scientific Rationale for
Dental Implant Design

Module 1 - Bone Biology, Anatomy and
Wound Healing
Healing mechanisms and bone physiology
Anatomy of the Maxilla and Mandible and
Anatomical Safety Zones
Pharmacology for Implant Dentistry
Chapter 11 carl e misch
Implant Body Designs

Cylinder Type
Wound Healing
Screw Type

Press fit
Combination of Features
A Cylinder or Press-fit Implant

Friction-fit Insertion
Wound Healing
May have less risk of pressure necrosis

Easiest to Insert
High initial success rates
After 5 years of loading, reports of the loss of crestal bone and implant
failure more often observed

Wound Healing
A report by Zechner et aJ. Evaluated the peri-implant bone over a 3

to 7 year period around functionally loaded, screw-type implants
with a machined surfaced V-thread and sandblasted, acid-etched,
squarethread design.
The range of bone loss in the study was 0.1 to 8.5 mm for the
machined V-thread and 0.2 to 4.8 mm for the rough surface, squarethreaded implant.

Wound Healing
The range of bone loss and the incidence of bone loss both indicate
the implant design or surface condition made a difference in this
report.
The prospective report by Karoussis et al. also indicated that implant

survival and marginal bone loss is related to implant design.

Wound Healing
In other words, several clinical reports found different implant

designs influence not only the implant survival, but also the amount
of early crestal bone loss after loading.
IMPLANT DESIGN RELATED TO

OCCLUSAL FORCES
Dental Implants function to transfer loads to surrounding biological
Wound Healing
tissues.
Thus the primary functional design objective is to manage (dissipate

and distribute) biomechanical loads to optimize the implantsupported prosthesis function
Force Type and Influence on

Implant Body Design
Three types of forces may be imposed on dental implant:
Compression (strongest)
Wound Healing
Tension (30% weaker)

Shear (65% weaker)

Limit shear forces on bone, because it is least resistant to fracture

under these loading conditions.
Body Design
An implant has a macroscopic body design and a microscopic
component to implant design:
1. The microscopic features (important during initial implant healing
Wound Healing
and the initial loading period)

2. The macroscopic implant body design is most important during
early loading and mature loading periods.
Cylindrical Implants
Smooth-sided, cylindrical implants:
Ease in surgical placement
Wound Healing
Larger shear forces

Smooth-sided, cylindrical, tapered implant:

Compressive load to the bone-implant
Interface, depending on the degree of taper
Cylindrical Implants
The greater the taper, the greater the component of compressive load.
Wound Healing
(not more 30 degree)
The greater the taper:

1. The less the overall surface area of the implant body under load
2. The less intial stability
Tapered threaded implant

1. No functional surface area advantage, because the threads of a screw
Wound Healing
bear the compressive loads to the bone.

2. Some surgical advantage during initial insertion, because it inserts
down within the osteotomy halfway before engaging bone.
Tapered threaded implant

3. The lesser surface area of a tapered implant increases the amount of
Wound Healing
stress at the crestal portion.
4. At the apical half are often less deep, because the outer diameter

continues to decrease. (limits the initial fixation).
Smooth-cylinder implant
A smooth-cylinder implant body results in essentially a shear load at

Wound Healing
the implant-bone interface.

Bone grows to a cylinder-shape implant during initial healing.
However, this type of body geometry must rely on a microscopic
retention system such as roughening or coating for the initial loading
Wound Healing
period:
1. Etch (acidetch, mechanical etch)
2. coatings (titanium plasma spray or HA)
If the The quality of the coating is altered:
Wound Healing
1. From friction during surgery

2. Infection
3. Mechanically removed during treatment of periimplantitis
4. From bone remodeling over years
the remaining smooth-sided cylinder is severely compromised for

healthy load transfer to the surrounding tissues.
Surface condition
The surface conditions of an implant may enhance:
Wound Healing
1. Bone-implant contact (BIC)

2. Adhesion qualities to the bone

However, the surface coatings on cylinders do not permit

compressive forces to be effectively transmitted to the bone cells,
because the microfeatures of the coating are too small for the cells to
be loaded in compression.
Surface condition
Therefore the surface area-bone contact percentage is greater during
Wound Healing
initial healing.
But the functional surface area during long-term loading is most
dependent on the macroscopic design of the implant body.
Surface condition
Numerous reports demonstrate roughened surfaces have higher BIC
Wound Healing
compared with machined surfaces.

Implant body design was more important than the surface condition
of the implant for crestal bone loss and overall BIC after loading.
Surface condition
Any smooth shear surface on an implant body increases the risk of
Wound Healing
bone loss because of inadequate load transfer.

The crestal bone loss contribute to an increase in crown height which
further magnifies stress from bending moments.
Force Direction and Influence on

Implant Body Design
The greater the angle of load, the greater the stresses to the implantbone interface.
Wound Healing
A 30-degree angled load will increase the overall stress by 50%

compared with a long axis load.
the long axis should be perpendicular to the curve of Wilson and
curve of Spee to apply a long axis load to the implant during occlusal
load in co.
Thread Shapes

Wound Healing
Thread shape is particularly important when considering longterm

load transfer to the surrounding bone interface. Figure 11-10
IMPLANT BODY: FUNCTIONAL VERSUS

THEORETICAL SURFACE AREA
Functional surface area is defined as the area that actively serves to

Wound Healing
dissipate compressive loads to the implant-bone interface.
Functional thread surface area, therefore, is that portion of the

thread that participates in compressive load transmission under the
action of an axial (or near-axial) occlusal load.

Wound Healing
Total theoretical surface area, which may include a "passive" area on

the implant that does not participate in load transfer , or has a feature
so small bone cannot adapt to load transfer.
IMPLANT BODY GEOMETRY VERSUS

OCCLUSAL LOAD
Duyck et al. also found that the bone density was equally distributed
Wound Healing
above and below a threaded implant after initial bone healing.

However, after dynamic loading,the bone implant density was greater

on the bottom of the thread face angle and less on top of the thread.

OCCLUSAL LOAD
Bolind et al. confirmed that The bone contact was:

Wound Healing
1. least at the tip of each thread (where the highest strain occurs)
2. the greatest under the thread face angle (where the bone is loaded

more in compression).

OCCLUSAL LOAD

Wound Healing
Therefore the design of the implant not only governs the initial
stability of the implant, but as important determines the BIC percent
and location of contact available for effective load transfer to the
bone after occlusal loading.
Thread Geometry
There are several parameters of an implant that may alter the

functional surface area. Three of these include:
Wound Healing
thread pitch
thread shape
thread depth
Thread Pitch
distance measured parallel between adjacent thread form features of

an implant. Figure 11-19).
Wound Healing
Thread Pitch
The smaller (or finer) the pitch:

Wound Healing
1. the more threads on the implant body

2. the greater surface area per unit length of the implant body.
Thread Pitch
Implant pitch may be made smaller when:
Wound Healing
1. Great forces
2. Bone quality is poor
3. Inadequate length
Thread Pitch

Wound Healing
The thread number is most significant for the shorter length

implants. For example, the Straumann ITI 6- and 8-mm-long
implants may only have three threads to carry the compressive load.
Thread Pitch

Wound Healing
The thread number may be affected by the implant crest module

design. When the implant body has an extended smooth crest
module, the number of the thread to support the occlusal load is
reduced
Thread Pitch
The surgical ease of implant placement is related to thread number.

Wound Healing
The fewer the threads, the easier to insert the implant.
Thread Shape
V-thread design is called a fixture and is primarily used for
Wound Healing
fixating metal parts together.

The reverse buttress thread shape was initially designed for
pullout loads.
Thread Shape
The square or power thread provides an optimized surface area

Wound Healing
for intrusive, compressive load transmission.

A buttress thread shape may also load the bone with primarily a
compressive load transfer.
Thread Shape
The V-shaped and reverse buttress thread shapes had similar BIC
percent and similar reverse torque values to remove the implant
Wound Healing
after initial healing .

The square thread design had a higher BIC percent and a greater
reverse torque test.
Thread Shape
Figure 11-25 A, A long axis load to an implant body with V-thread
Wound Healing
with a 30-degree thread face converts the load direction to a 30degree angle at the implant interface
B, A plateau or square-thread design can deliver a compressive
force to the bone.
Thread Shape
Figure 11-25 A, A long axis load to an implant body with V-thread
Wound Healing
with a 30-degree thread face converts the load direction to a 30degree angle at the implant interface
B, A plateau or square-thread design can deliver a compressive
force to the bone.
Thread Depth
The thread depth of an implant refers to the distance between the
Wound Healing
outer (or major) diameter and the inner (or minor) diameter of
the thread.

The deeper the thread depth, the greater the functional surface
area.
Thread Depth
The more shallow the thread depths, the easier it is to thread the
implant in dense bone, and the less likely bone tapping is
Wound Healing
required prior to implant insertion.

The implant increases in surface area by 15% to 25% for every 1mm increase in diameter.
Crest Module Considerations

is the transosteal region, which extends from the implant body
and often incorporates the antirotation components of the
Wound Healing
abutment implant connection.

The crest module of the implant has a surgical influence, a

biological width influence, a loading profile consideration and a
prosthetic influence.

The crest module of an implant should be slightly larger than the
outer thread diameter of the implant body:
Wound Healing
1. Provides a barrier for the ingress of bacteria or fibrous tissue

during initial healing
2. And provides greater initial stability of the implant following
placement.
The larger crest module diameter also increases surface area,

Wound Healing
which can further decrease stress at the crestal region.
The increase in crest module diameter increases the platform of

the abutment connection with a stress reduction to the abutment
screw during lateral loading.

Wound Healing
Figure 11-37 The crest module with a cylinder metal

collartransfers primarily shear forces to the bone (for left).

Wound Healing
Figure 11-41 the The external hex designs allow the fabrication of
threads closer to the crestal region of the irnplant.
Apical Design Considerations

The apical portion of a root form implant is most often tapered to
permit the implant to seat within the osteotomy before the
Wound Healing
implant body engages the crestal bone region.

As a result, the patient does not need to open the mouth as wide,
which is especially of benefit in the posterior regions of dentate
patients.

Most root form implants are circular in cross section.This
permits a round drill to prepare a round hole,precisely
Wound Healing
corresponding to the implant body.

however, do not resist torsion/shear forces when abutment

screws are tightened,or when single-tooth implants receive a
rotational(torsional) force.

As a result, an antirotational feature is incorporated into the
implant body, usually in the apical region.
Wound Healing
The most common design is a hole or vent.

In theory, bone can grow through the apical hole and resist
torsional loads applied to the implant.
The apical hole region may also increase the surface area
available to transmit compressive loads to the bone.
A disadvantage of the apical hole occurs when the implant is

Wound Healing
placed through the sinus floor or becomes exposed through a

cortical plate.

The apical hole may fill with mucus and become a source of
retrograde contamination.

Another antirotational feature of an implant body may be flat
sides or grooves along the body or apical region of the implant
body.
Wound Healing
The apical end of each implant should be flat rather than

pointed.
Pointed geometry has less surface area , thereby raising the
stress level in that region of bone.
IMPLANT BODY BIOMATERIAL

RELATED TO FRACTURE
Titanium alloy (Ti-6Al-4V) has been shown to exhibit the most
attractive combination of mechanical and physical properties,
Wound Healing
corrosion resistance, and biocompatibility of all metallic
biormaterials.

The primary advantage of titanium alloy as compared with other

grades of titanium is its strength.
IMPLANT BODY BIOMATERIAL

RELATED TO FRACTURE
Titanium and its alloy represent the closest approximation to the

Wound Healing
stiffness of bone of any surgical grade metal used as an artificial

replacement for skeletal tissue.

Even though it is almost 6 times stiffer than dense cortical bone.

Scientific Rationale For Dental Implant Design

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Scientific Rationale for

Dental Implant Design

Chapter 11 carl e misch

Implant Body Designs

Healing mechanisms and bone physiology

A Cylinder or Press-fit Implant

May have less risk of pressure necrosis

Pharmacology for Implant Dentistry

Module 1 - Bone Biology, Anatomy and

A report by Zechner et aJ. Evaluated the peri-implant bone over a 3

Module 1 - Bone Biology, Anatomy and

The prospective report by Karoussis et al. also indicated that implant

Module 1 - Bone Biology, Anatomy and

In other words, several clinical reports found different implant

IMPLANT DESIGN RELATED TO

Healing mechanisms and bone physiology

and distribute) biomechanical loads to optimize the implantsupported prosthesis function

Force Type and Influence on

Tension (30% weaker)

Healing mechanisms and bone physiology

Limit shear forces on bone, because it is least resistant to fracture

and the initial loading period)

Larger shear forces

Healing mechanisms and bone physiology

Smooth-sided, cylindrical, tapered implant:

(not more 30 degree)

Healing mechanisms and bone physiology

The greater the taper:

Anatomy of the Maxilla and Mandible and

Pharmacology for Implant Dentistry

2. The less intial stability

Tapered threaded implant

bear the compressive loads to the bone.

Tapered threaded implant

stress at the crestal portion.

Healing mechanisms and bone physiology

Anatomy of the Maxilla and Mandible and

continues to decrease. (limits the initial fixation).

Pharmacology for Implant Dentistry

A smooth-cylinder implant body results in essentially a shear load at

the implant-bone interface.

1. From friction during surgery

Pharmacology for Implant Dentistry

the remaining smooth-sided cylinder is severely compromised for

1. Bone-implant contact (BIC)

Healing mechanisms and bone physiology

However, the surface coatings on cylinders do not permit

compared with machined surfaces.

bone loss because of inadequate load transfer.

Force Direction and Influence on

A 30-degree angled load will increase the overall stress by 50%

Module 1 - Bone Biology, Anatomy and

Thread shape is particularly important when considering longterm

IMPLANT BODY: FUNCTIONAL VERSUS

Functional surface area is defined as the area that actively serves to

dissipate compressive loads to the implant-bone interface.

Healing mechanisms and bone physiology

Functional thread surface area, therefore, is that portion of the

Anatomy of the Maxilla and Mandible and

thread that participates in compressive load transmission under the

Pharmacology for Implant Dentistry

action of an axial (or near-axial) occlusal load.

Module 1 - Bone Biology, Anatomy and