Implant Script 1Implants History Definition

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Dental implantology lec 1 2013

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Dental implantology course has multiple spechialisms incorporated into

it, mainly prosthodontic part and there are radiological and periodontal

and surgical parts.

Radiology part is concerned about bone volume and texture and CT

scan, while surgical part is concerned with bone grafting in severe cases.

Dr.Saleh al shannaq will be the course coordinator, it is 2 hours credit

course, it is purely theoretical, 1 credit hour every semester.

Because more than one instructor will cover this course, every instructor

will be responsible of the reference of his lec. Anyway Dr.salehrecommended "cotemporary implant dentistryas a suitable book for

us.

For other information see the syllabus

.

History of dental implant:

Many of us think that implant is something new, but it seems that it has

an old history!

Maya civilization which is in south America worked with

endosseous implant 1350 yr. before per-ingvar branemark

(implant inventor) work with titanium.

Archeologists excavated Maya burial sites Honduras in 1931 and

found fragments of mandible of Maya origin and they thought

that she is a female, dating from about 600 AD. They found three

shells in a tooth shape in anterior mandible were osseointegrated

with the compact bone that means this female has these shells in

her mandible before her death, because no way of

osseointegration after death !!!


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In cases of kidney implant or retinal implant, kidneys or retina are

translated into living individual from another person , it's not the same

case in teeth implant although it named "implant" y3ny teeth are not

translated from person to person , it's not the same case !!

Implant is not analogous to tooth, isn't a living tissue, is not a root it's a

device made of alloplastic material ( inert material that does not react

with the body tissues) and usually it's titanium beneath the mucosal

and/or periosteal layer and on/or within the bone to provide retention

and support for a fixed or removable dental prosthesis.

Nowadays, studies are being achieved to use zirconia and fiber-induced

material as material for implants.

Implant is not final fixed prosthesis so it could be fixed over implant,

removable over implant, fixed-removable over implant.

Implant is also called "fixture" y3ny some thing fixed in place. And it

could be cylindrical or screw ( ) and it could solid or hollow ( y3ny

have holes inside it in which bone is entered).

Definition of dental implant

Here this pic .illustrates the maindifferences between a natural tooth

and an implant with crown.

In which natural tooth has a root,

PDL,crown.

While implant does not have PDL, it

has ankylosed titanium screw in the

bone.


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Is implant contraindicated in grower pts.? And why?

Yes, it's contraindicated in grower pts. Who are below 20 yrs.

Especially males according to their late growth spurt compared to

females.So if it's done to grower pt. teeth will continue to erupt as growth

continues so the surrounding teeth will erupt while the implant is

ankylosed and that means it will not move , so for example after 3

yrs. The surrounding teeth will be higher in occlusion compared to

it and it looks like submerged tooth.

Like in pediatric cases in which infra-occluded tooth without PDL

so it will not supraerupt.

Teeth in implant are slightly out of occlusion when they are

opposed to natural teeth.( why)?

Because while the pt is squeezing teeth opposed each other the

implant will be higher in the occlusion compared to natural tooth.

, because natural tooth can be depressed in socket 120

micrometer while the implant can't because of ankylosis.

So implant teeth have to be slightly out of gentle bite.

Endosteal: titanium pieces are inserted in the bone after

oseotomy .. it could be screws or cylinders or in some cases

plates or blades when having thin bone.

An example of threaded solid screw

NOTE

Types of dental implant


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The most commonly used is screws either cylindrical or

threaded tapered having macro-threads or micro and

macro-threads and the least commonly are plates or

blades.

subperiosteal: y3ny elevating a flap and putting titanium piece

like plate subperiosteal then bone will be formed over this

piece.

They are not common such as endosteal because of their

high failure rate; even in cases of bone loss we do bone

grafting.

The most commonly marketing is screw and cylinders either

macro-threaded or micro and macro-threaded and micro-threaded tapered or parallel.

Different lengths and different diameters, for example previously they

used to use 20-22 mm in lengths but nowadays it's just 5-6mm and

maximum to 13 mm.

That means the longer the implant NOT the better it is.

In general implant diameter has to be accommodated with the size of

restored tooth, but it is not a rule!!

So the design is the most important factor, what makes Petra a piece of

stone the second wonder in the world?

It's just the design !!

Y3ny piece of titanium by just having special design will be rescuer to ptlost teeth after an accident and makes him again naturally looking!!

Here are examples

of parallel, parallel

and tapered, tapered

body.


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The failure of implant is much worse than failure of conventional

prosthesis.

Firstly dental implant just used in pts with missed teeth either one

tooth or all teeth.

What ere the treatment options for replacing upper and lower

edentulous pt. ?

Complete denture.. implant supported prosthesis

What are the treatment options for replacing missing tooth?

- No treatment (in case of missing wisdom tooth, for example).

- Removable partial denture.

- Bridge (fixed partial denture) by all its kinds: conventional,

fixed-fixed, movable-fixed and cantilever.

- Implant supported prosthesis (removable, fixed) according to

remaining bone, lip support, many other factors.- Combination y3ny more than one option, implant with RPD ,

implant with FPD, implant with nothing!

.

After putting an implant into the bone, what are the kinds of restoration

that is put over the implant?

- Direct to fixture or Direct to implant: simply the restoration is

connected to the implant by screw.

It's used when the operator fixed the implant correctly to the bone in

the proper position without any wrong deviation so simply its final

restoration, restoration screw and implant!

Treatment options

Restoration of an implant


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- Angulated or not proper exit point of implant in which we can't put

the final screw directly over it so we use an abutment.

In such case we use firstly restoration with accessory screw or

occlusal screw and also named transverse screw or lateral crew

or horizontal screw or cross-pin screw or without screw as in

Jordan we just cement it, then this screw over an abutment

and the abutment over prosthetic screw over an implant.

Prefabricated

aesthetic abutment

for correction of

malpositioned

implant.


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Okay let's discuss cases in slides :

In case of proper position of dental implant into the bone the final

restoration will be just one piece without an abutment so called

direct to fixture .

In cases of posterior teeth implant we can use ceramic onlay ,gold

onlay and implant crown, then we cover the screw opening in the

crown by composite , and after a period of time composite will be

stained.

In cases of improper position of implant we use a restoration with an

abutment.

Note: the number of implants are not always the same as the numberof restored teeth because as we said simply the implant is not a

tooth!.

In case of missing lateral and premolars, implant tooth is

cemented over an abutment and they will be out of occlusion in

lateral excursion.

Selected pictures for abutments, I hope that they are clear!


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Case of pt. had an accident and lost two central incisor, lateral and

canine in which three implants are placed direct to fixture except

one of them which needs an abutment.

In a case of missing lower anterior area from canine to canine,

implant is done although there is bone resorption.

Implant dentistry develops and used the computer which scanned

the pt mouth and screen the bone in 3-D view, and the operator

select the location of implants according to surgical guides, then

the implant frame came ready according to operator guidance and

without elevating any flaps the implants are inserted.

And there is a margin of error by 1 mm, because the operator may

not correctly position the implant into the bone or because of not

elevation flap and just insertion over soft tissue which could be

flabby!

So operator can use abutment in case of malpositiond implant or the

design needs abutment!

In case of denture over implant , denture will be click on the locators

on the mouth instead of depending on saliva and cohesion .

-

Done By : Mays Jaradat.

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3Pic 1: pre-treatment of lower

edentulous ridge.

Pic 2: titanium implant and titanium

bar.

Pic 3: these are plastic clips imbedded

into denture attached to the bar.

Documents

Implant Script 1Implants History Definition