IMPLANTS

The Future of
Prosthodontics

What is an
Implant???

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

History

936 1013 First documented placement of implants

Albucasis de Condue used ox bone to replace teeth

1809 Maggiolo - Gold roots which were fixed with adjacent teeth by
means of spring

1887

Platinum post coated with lead

1895

Gold or iridium tubes were implanted Bonewell

1905

Porcelain corrugated root implant

1913

Hollow basket implant meshwork or iridium , platinum , gold

- Greenfield

1948

Insertion of first viable subperiosteal implant Goldberg

1952 Threaded implant design of pure titanium

Endosteal implants - Branemark

Single/multiple missing
tooth/Teeth

What are the treatment options

available ???????

Single/multiple missing
tooth/Teeth

1. Removable Partial Denture

(R.P.D.)

2.Fixed Partial Denture (F.P.D.)

3. Implant Prosthesis

Removable Partial Denture

(R.P.D.)
DISADVANTAGES :1. do not maintain bone
- compromise the
esthetic result
2. bulk need for
cross arch stabilization
3. food debris , plaque
4. movement
-speech
-function
5. highest loss of abutment teeth

Fixed partial
denture
(F.P.D.)

DISADVANTAGES :-

1. caries and endodontic

failure of abutment teeth is the
most common failure
2. increased plaque retention of pontic increases caries
and periodontal disease risk
3. damage to healthy teeth
4. fracture ( porcelain , tooth )
5. esthetics ( anterior region )
6. uncemented restorations

Fixed partial denture

(F.P.D.)
It is contra indicated in
1. Poor abutment teeth support
2. inadequate hard and soft tissue in esthetic regions
3. patient desire
4. young patients with large pulp horns

Implants for
single/multiple tooth
replacement
ADVANTAGES :1. Adjacent teeth do not require splinted
restoration
- less risk of caries
- less risk of endodontics
- Less risk of porcelain fracture
- Less risk of uncemented restoration
- Less fracture of tooth
2. Psychological need of patient
3. Improved hygiene conditions
- less decay risk
- less pontic overhang
4. Decreased cold and contact sensitivity
5. Improved esthetics
6. Maintains bone in site
7. Decreases adjacent tooth loss

Completely Edentulous Patient

Treatment options

Conventional removable dentures

Implant supported prosthesis

Decreased performance of
conventional complete dentures

1.
2.
3.
4.
5.

Bite force is decreased from 200 psi to 50 psi

Masticatory efficiency is decreased
More drugs are required to treat gastrointestinal disorders
Food selection is limited
Healthy food intake is decreased

Implants for complete dentures

1. maintain bone
2. restore and maintain occlusal vertical
dimension
3. maintain facial esthetics (teeth
positioned for appearance versus
decreasing denture movement )
4. Improve phonetics
5. Improve occlusion
6. Improve / regain oral proprioception
7. Increase prosthesis success
8. Maintains muscle of mastication and
facial expression
9. Reduce size of prosthesis
10. Improve stability and retention of
removable prosthesis
11. More permanent replacement
12. More psychological health

Indications for implants

Edentulous patient
Partially edentulous patient with history of difficulty in
wearingR.P.D.
Patient requiring long span F.P.D.treatment
Patient who refuses wearing a removable prosthesis
Patient with severe changes in C.D.bearing tissues
Poor oral muscular coordination
Parafunctional habits that compromise prosthesis stability
Unrealistic patient expectation for complete denture
Hyperactive gag reflex
Patient psycologically against removable prosthesis
Unfavourable number and location of abutments
Single tooth loss, avoid preparation of sound teeth

ATTACHMENT MECHANICS

Mechanism Of Integration Of
Endosteal Implants

2 concepts were proposed

1. Dr. Branemark concept
concept of osseointegration
2. Weiss concept
concept of fibro osseous integration

WEISS THEORY
1. fibro ossseous ligament formed
between implant and the bone
collagen fibers at bone implant
interface
ligament = periodontal ligament
1. early loading of the implant was advocated
Fibrous connective tissue does not act as shock
absorber nor resemble PDL.
The non-mineralised connective tissue results from
inflammtion with a tendency to

proliferate, gradually increasing implant

mobility.

BRANEMARKS THEORY OF
OSSEOINTEGRATION
Bone is laid very close to the
implant material without an
intervening Connective tissue
the apparent direct attachment or
connection of osseous tissue
to an inert alloplastic material
without intervening connective
tissue
- G.P.T.

IMPLANT should be left out of

function during the healing phase

The Interface

Surgical area undergoes a remodelling process just like an

extraction site

If overloading then - implant failure

Bone grows into the irregularities( macroscopic & microscopic )

of the implant surface

depending on the reaction with bone :1. bioactive ( hydroyapatite )

2. bio inert ( metals )

MECHANISM OF
OSSEOINTEGRATION
First mechanism

Integration occurs mainly through osteoconduction

Connective tissue scaffolding

Bone-producing cells( osteoblasts ) migrates

Second mechanism

de novo bone formation wherein a mineralized interfacial

matrix is deposited along the implant surface
Surface topography will determine the bond strength of
bone to the implant surface

Factors Affecting Osseointegration

1. Occlusal load
- 2 stage implant insertion is advocated
- overloading prematurely will cause failure
2. Biocompatibility of material

- commercially pure titanium

- commercially pure noibium

- hydroxyapetite
3. Implant design

- most conducive - cylindrical

4. Implant surface

- mild surface roughness

Factors Affecting Osseointegration

5. Surgical site

healthy site is required

6. Surgical technique

minimum possible trauma

7. Infection control