IMPLANTOLOGY QUESTIONS & ANSWERS

•DR.MOUSTAFA MOAMEN •MDs. ORAL & DENTAL MEDICINE CAIRO UNIVERSITY•Assistant lecturer IN PROSTHESIS DEPARTMENT CAIRO UNIVERSITY•FELLOW TO THE INTERNATIONAAL CONGRESS OF ORAL IMPLANTOLOGISTS (ICOI)•PRESIDENT OF THE CLINICAL IMPLANT SOCIETY OF EGYPT (CISE)

COURSE OBJECTIVESTHEORATICAL PART:To be able to identify the advantages of implant

dentistryTo be able to identify cases capable for implant

placement

Practical part:To be able to diagnose, place & successfully

restore a single tooth replacement implant case

Implant Course map

System components & step by step procedures

Diagnosis & treatment planning

Basic knowledge

Then exam

What is a dental implant?A device of biocompatible material placed within the mandibular or maxillary bone

Why do we need implants?P,O.C. Removable Fixed ImplantMain prob Removable Tooth reduction surgery

Survival rate after 10 years

35% 50 %With precious alloys

85% -97%

Abutments 80% need repair within 10 years& 44% will be lost

15% will need endo. Abutment Screw loosening may occur easily retightened

Increased mobility, plaque, bleeding upon probing, and caries of abutment teeth

Bone Accelerated bone resorption especially from tissue supported restorations

Bone resorption from disuse atrophy under the pontics

Minimal to no resorption

What are the types of dental implant?I. Endosteal implantsRoot form implantsEndodontic stabilizersPlate or blade form

implantII. Subperiosteal implant

flap margins→ heal by primary intention soft tissues → around implants simulates that

around tooth structure i.e (attachment & junctional epithelia & free & attached gingivae all are present)

bone healing→granulation tissues (within 1 week after

implantation) → woven bone formation(within 2 weeks) → bone growth &mineralization(within 4 weeks) →bone maturation &organization(6-8weeks)

How does healing take place around dental implants?

What is osseointegration?It is the direct structural & functional

connection between living bone & the surface of a load bearing artificial implant without any intervening tissues

What are the criteria of a successfully osseointgrated dental implant?

Clinically immobileNo radiolucency around the implant< 0.2 mm bone loss / year after the 1st year Absence of signs &/or persistent symptoms as

(pain, pus, paresthesia or infection)

What is meant by the available bone?Available bone describes

the amount of bone in the edentulous area considered for implantation.

It is measured in: 1. Width (buccolingual) 2. Height (from bone crest to

landmark)3. Length (mesiodistal)4. angulation5. crown height space

1. The available bone height The height of available bone is measured from the crest

of the edentulous ridge to the opposing landmark.

1. The available bone height

Minimum bone height needed:

Implant length (at least 10mm)+ 2mm

This additional 2-mm to permit for:

1. surgical error

2. osteoplasty

1. The available bone height

Importance Selection of the proper implant length

which:affects implant/crown ratioaffects primary stability immediate

loading↑↑ surface area(SA) (every 1mm

contributes for 10-14% SA ↑↑) → better stress distribution

2. Available Bone Width B-L dimension

The minimum needed bone width is: 2mm > implant diameter for predictable survival These dimensions provide ≥ 1 mm of bone on

each side of the implant at the crest.   Importance: Determination of implant diameter which

affects; ↑↑ SA (every 1mm →↑↑ SA by 30-40%) →

Better Stress distribution especially around the implant crest which is the most vulnerable area for future bone resorption

Can we increase the bone width?

3. Available Bone Length The mesiodistal length of available bone in an edentulous area is

often limited by adjacent teeth or implants.   As a general rule, the implant should be at least>1.5 mm

from an adjacent tooth and 3 mm from an adjacent implant.

3. Available Bone LengthThis dimension allows for Crown contouring (emergence profile)compensation for the width of an implant

crestal defect, which is usually < 1.4 mm.

4. Available Bone AngulationDefinition: It is the angle between the long

axis of the remaining alveolar ridge with the long axis of the abutment in the planned restoration

  The initial alveolar bone

angulation represents the natural tooth root trajectory in relation to the occlusal plane

the bone angulation changes after the loss of teeth, especially in the anterior edentulous arch

30˚

. Available Bone AngulationImportance:Bone angulation →

placement of the implant with angled abutment → angled load to an implant body ↑↑ the crestal stresses, so the less the bone angulation the better the stress distribution

4. Available Bone Angulation

Relation to ridge width

5. Crown Height Space The crown height space (CHS) is defined as the vertical distance

from the crest of the ridge to the occlusal plane. Importance: It affects the: Esthetics & appearance of the final prosthesis and the amount of moment force on the implant and surrounding

crestal bone during occlusal loading. Maximum acceptable CHS For an ideal treatment plan, the CHS should be ≤ 15 mm for ideal

conditions

Implant patient should have

Abundant available bone

Money $$

Misch classfication

8. criteria of division A (abundant) available bone ( Carl Misch classification)Width > 6 mmHeight > 12 mmMesiodistal length > 7 mmAngulation of occlusal load

(between occlusal plane and◦implant body) < 25 degrees

Crown height space ≤ 15 m

What is meant by bone density?

It refers to the internal structure of bone regarding its compact & cancellous components & reflects a number of biomechanical properties, such as strength and modulus of elasticity

As well as a determining factor in treatment planning, implant design, surgical approach, healing time, and initial progressive bone loading during prosthetic reconstruction

9 . Classify bone according to quality?

Is bone density related to specific jaw locations?

3% D1

50% D2

46% D3

1% D4

0% D1

10% D2

50% D3

40% D4

0% D1

10% D2

50% D3

40% D4

6% D1

66% D2

25% D3

3% D4

3% D1

50% D2

46% D3

1% D4

3% D1

50% D2

46% D3

1% D4

Does bone density affect implant dentistry?

Difference between implant E & bone E will lead to implant micromobility inside the bone creating microstrain on the implant bone interface

Does bone density affect implant dentistry?Implant to bone contact in D1 > D2 > D3

> D4 D1 D4

To summarize…..

Bone density affects

implant micromovemen

t during function

Bone to implant contact

So unfavorable bone density stress concentration

Does bone density affect treatment plan?

... unfavorable bone density stress concentration

... Stress = Force/Area... to ↓ stress we have to ↑ surface area• Implant number• Implant width• Implant length• Implant design• Implant surface condition

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