Introduction to

Dental Implant

A dental implant is a small, sturdy, titanium post that acts as the root structure would for a natural tooth

What is Dental Implant ?

History and Present Status of Implant

Dentistry

16 thDark stone ( Egyptian-South American)

17 thCarved ivory teeth

Ancient Implants

1809Gold implant e.20th Lead, iridium, tantalum, stainless

steel, and cobalt alloy 1913hollow basket iridium + gold wires

(Greenfield)

Early Implants

1937Adams’s submergible threaded cylindrical implant with round bottom

1938Strock’s (long term) threaded vitallium implant

(cobalt+chrome+molybdenum)

The modern implants appear to be variants or composites of some of the designs of early implants

Early Implants

1952Swedish surgeon,

Professor Per- Ingvar Branemark, coined the term

“osseointegration”- pure titanium comes into direct contact with the living bone tissue,

Modern Implants

1965 Dr. Brånemark placed his first titanium dental implant into a human

volunteer, a Swede named Gosta Larsson. He received implant at the age of 34, died at the age of 75, having used his implants for over 40 years

1981 Nobelpharma AB founded in to focus on dental implantology.(later to

be renamed Nobel Biocare)

Modern Implants

Other Different Types of Dental Implants

1967Linkow blade implant-in narrow ridge

1970Roberts and Roberts – Ramus titanium blade implant

Blade Implants

1943 Dahl of Sweden placed with 4 projecting post

Placing implants on and around bone rather than in it

CT-generated CAD-CAM model

Subperiosteal Implants

1975Small introduced transosteal mandibular staple bone plate

Limited to mandible only

Transosteal Implants

Component and Coposition of Dental

Implant

Component

Composition Titanium

implant: Titanium alloy

(Ti-6Al-4V)

Lightweight Biocompatible corrosion resistant

strong & low-

priced

Zirconium implant : Zirconium oxide (ZrO2)

High resistance to fracture and heat

Metal-free: white color of Zirconium substitutes the metallic appearance of Titanium

Indication and

Contraindication

What are the Alternative Solutions

Partial and Full Dentures

Crowns

Bridges

Inability to wear a removable partial or complete denture.

Need for long span fixed partial denture with questionable prognosis.

Unfavourable number and location of potential natural tooth abutments

Single tooth loss that would necessitate preparation of minimally restored teeth for fixed prosthesis 

Indication

Medical:   Terminal illness. Pregnancy. Uncontrolled metabolic disease Inability to restore with a prosthesis. Immune diseases Radiotherapy of head. Acute illness Bleeding or clotting disorder Osteoporosis with medication on Forxamex ( Bisphosphonate ) (?

)Dental:    Anatomy- nerves too close,sinus, or insufficient bone quantity Local pathology- cyst, root stumps, gum problems Bad oral hygieneGeneral : Financial difficulty No Moivation or non cooperative History of immune deficiency Bleeding or clotting disorder

Contraindication

Update: OsteoporosisLisa L. Willett, MDFebruary 9, 2010

General Medicine Noon Conference

Today’s speaker has no conflict of interest to disclose. The University of Alabama School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

UAB School of Medicine designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit (s) Physicians should only claim credit commensurate with the extent of their participation in the activity.

Osteoporosis “Porous Bones”

Diminished bone mineral density◦ 2.5 SD below mean for normal

Disrupted bone microarchitecture Decrease in bone strength Increase in fracture risk 8 million women, 2 million men in US

American Association of Oral and Maxillofacial Surgeons Position Paper on Bisphosphonate-Related Osteonecrosis of

the Jaws 2009 Update

Journal of Oral and Maxillofacial Surgery May 2009;67(5):2-12

Bisphosphonate-Related Osteonecrosis of the Jaws

Definition: BRONJ

Current or previous bisphosphonate Rx

Exposed bone in maxillofacial region, 8 wks

No history of radiation therapy to the jaws

Oral bisphosphonates for osteoporosis and BRONJ

Case reports > 3 years treatment But much less than with IV monthly

bisphosphonates in cancer patients ◦ 0.06% Kaiser-Permanente (PROBE, n=13,000)◦ 0.01 – 0.04% Australian surveillance◦ 0.004 German Central Registry

Risk Factors for BRONJ Drug related: IV route, cancer doses Duration: > 3 years for oral treatment Local risk factors

◦ Dentoalveolar surgery - ↑ risk 7-fold extractions, implants, periodontal surgery

◦ Concomitant oral disease

Cancer + iv + dental procedure = 5 - 21-fold increased risk compared to cancer + iv without dental procedure

Prevention of Osteoporosis Adequate calcium 1,200 mg daily Adequate Vitamin D 400-1,000 IU daily Exercise Minimize risk factors

Risk Factors Tobacco Excessive alcohol Medications – steroids, dilantin Hyperthyroidism Hyperparathyroidism Low body weight Family history

Different Types of Implants

About 200 implant manufacturing companies in the world

800,000 dental implants were placed in the United States last year.

Anatomic Zicornium Dental Implant

Impalnt Made in China

Medical grade titanium Safe and durable Non-toxic side effects Corrosion-resistant Light weight

 

Nobel biocare31%

Straumann19%Biomet/3i

11%

Zimmer9%

Dentsply6%

Others24%

Market Shares of Major Implant Company

2009

Geographic Analysis

Europe42%

North Americas31%

APAC19%

RoW8%

Geography wise Market Share of Dental Implants Market

2009

Advantage and

Disadvantage

Preserve tooth structure. Preserve bone from resoption. Psychological improve quality of patient’

life. Hygienic. Function.

Advantage

To replace one or more teeth To provide support for a partial denture To increase the support and stability of full

upper or lower denture To enhance chewing comfort To increase confidence while smiling, talking

and eating To improve your overall psychological health To improve esthetic appearance and

regain over all confidence

Can be a costly alternative for replacing a single tooth

The length of time required from initial dental implant placement to implant restoration

Invasive surgical procedure

Disadvantage

Procedures

First Surgical Phase (Implant Placement)Under Local anesthetic the dentist places dental implants into the jaw bone with a very precise surgical procedure. The implant remains covered by gum tissue while fusing to the jaw bone.

Second Surgical Phase (Implant Uncovery)After approximately six months of healing. Under local anesthetic, the implant root is exposed and a healing post is placed over top of it so that the gum tissue heals around the post.

Prosthetic Phase (Teeth)Once the gums have healed, an implant crown is fabricated and screwed down to the implant.

Procedure

Clinical procedure: Surgical either one stage or two stage

(healing period in between). Prosthetic

Healing period: Implant placed in less dense bone required

more time for healing Mandible 3-4 months Maxilla 6 months Bone graft 6-9 months

http://www.youtube.com/watch?v=ZLms9455d_I&feature=related

http://www.youtube.com/watch?v=BRv6kxuD1ts&feature=related

http://www.youtube.com/watch?v=mmaXcThuou4&feature=related

Post-Operative Instruction

Diet FLUID INTAKE IS VERY IMPORTANT.

Bleeding Expect minor bleeding or OOZING from the operative

site. This bleeding may continue throughout the first day

Pain

Swelling Swelling usually develops during the first 12-24 hours

following surgery, often peaking on the 3rd post-operative day

Try to avoid smoking completely, as it tends to slow the healing process and may also contribute to infection & prolonged discomfor

Maintenance After Restoration

Maintenance◦Primary goal is to protect and maintain “tissue-integration”;

good oral hygiene is a key element!

Implant Guidelines

Water : 4 or 6 month recall Water : waterpik ( two times a day ) Water : gargle with drinkiing water

Water! Water! Water !

Waterpik

Fixed Hybrid Prosthesis

- Hygiene care with a proxy brush

Case Presentation

Single ImplantCase 1

Case 2

Case 3

Multiple ImplantsCase 1

Case 2

Case 3

Case 4

Single Arch Case 1

Full MouthRehabilitationCase 1

Case 2

Implant OverdentureCase 1

Case 2

Implant in Cancer PatientCase 1

Case 2