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Recent advances in
Implantology Presented by
Pallavi Chavan
Introduction
The science of implantology is highly dynamic Ever since its
introduction into the field of dentistry by Dr Branemark it has
undergone numerous modifications and improvements
With each improvement and advancement made implantology
has proved to be a boon in disguise to the society
Contents
Advances in Diagnostic imaging
Recent advances in Implant design
Advances in Implant materials
Advances in commercially available implant systems
Software simplifying treatment planning
Recent advances in Implant Abutments
Implant -Abutment connection
New concepts in Implant rehabilitation
Conclusion
References
Advances in
Diagnostic
Imaging
Imaging
Phase 1 Pre-prosthetic implant
imaging
Phase 2 Surgical and interventional implant imaging
Phase 3 Post-prosthetic implant
imaging
Determines the
bull Quantity quality and
angulation of bone
bullRelationship of critical
structures to prospective
implant sites
bull The presence or absence of
disease at the proposed
surgical sites
Evaluates the
surgical sites during
and immediately
after surgery
Evaluates the long-term
change
bull Crestal bone levels around
each implant
bull Changes in mineralization or
bone volume
ZONOGRAPHY
A modification of the panoramic x-ray machine for making
cross sectional images of the jaws
The tomographic layer is approximately 5mm
For appreciation of spatial relationship between the critical
structures and the implant siteLimitations
bullTomographic layers relatively thick
bullAdjacent structures blurring and superimposition
bullNot useful for determining the differences in
bone density or for identifying disease at implant
site
Tomography
Tomography is the generic name formed by the greek
words lsquotomorsquo(slice) and lsquographyrsquo(picture)
Enables visualization of a section of patientrsquos anatomy by
blurring other regions above and below the site of interest
For dental implant patients high quality complex motion
tomography is required
Computed tomography (CT)
CT was invented by Sir Godfrey Hounsfield and was introduced in
1972
Computed tomography (CT) is a digital and mathematical imaging
technique that creates tomographic sections and allows soft tissues
and hard tissues to be visualized simultaneously
Ideally tomographic sections spaced 1 to 2 mm enable evaluation of
implant site and 3D appearance of alveolus
With latest CT scanners images with sectional thickness of 025 mm
can be obtained
The advantages of CT based systems are
Uniform magnification
High contrast image with well-defined image layer free of
blurring
Easier identification of bone grafts or hydroxyappatite materials
used to augment maxillary bone in sinus region
Multiplanar views
Three-dimensional reconstruction
Simultaneous study of multiple implant sites
Availability of soft tissue for image analysis
Disadvantages
Limited availability of reconstructive software
Higher dose of radiation
Lack of understanding of dentists
Lack of usefulness for implant interface follow-up because of
metallic streak artifacts
Expense
Recent advances in Computed Tomography(CT)
Tuned Aperture CT (TACT)
Tuned aperture computed tomography (TACT) by Webber is a
relatively simple faster method for reconstructing tomographic
images
It is based on the concept of tomo-synthesis and optical-aperture
theory
TACT uses 2-D periapical radiographs acquired from different
projection angles as base images and permits retrospective
generation of longitudinal tomographic slices (TACT-S) lining up in
the Z axis of the area of interest
The overall radiation dose of TACT is not greater than 1 to 2 times
that of a conventional periapical X-ray film
The resolution is stated to be similar with 2-D radiographs
Artefacts associated with CT such as starburst patterns seen with
metallic restorations do not exist with TACT
The big conceptCone Bean Computed Tomography
Cone Beam Computed Tomography
Fan beam Cone beam
Software programs incorporating sophisticated
algorithms including back-filtered projection are applied
to these image data to generate a 3D volumetric data set
which can be used to provide primary reconstruction
images in 3 orthogonal planes (axial sagittal and coronal)
CBCT is devoted to maxillofacial area to scan and
visualize jaw bone lesions especially cancellous bone
It gives all the information of a CT but at 18th the
radiation dose and at a lower cost
CBCT is categorized into large medium and limited volume units based on the size
of their field of view (FOV)
Large (FOV)
bull 15-23 cm
bull Maxillofacial trauma
bull Orthodontic use
bull TMJ diseases
Medium FOV
bull 10-15 cm
bull Mandibulo-maxillary imaging
bull Pre-implant planning
bull Pathology
Small FOV
bull lt 10 cm
bull Endodontic applications
Advantages of CBCT
X-ray beam limitation
Image accuracy
Rapid scan time 10ndash70 seconds
Software can be made available to the user
Dose reduction Effective dose is 98 smaller than conventional CT
Reduced image artifact
Interactive computed tomography(ICT)
bullThis technique enables transfer of the imaging study to the
clinician as a computer filehellip
bullThe clinicianrsquos computer becomes a diagnostic radiologic
workstation with tools
bullAn important feature of ICT is that the clinician and radiologist can
perform ldquoelectronic surgeryrdquo (ES)
bull With an appropriately designed diagnostic
template ES can be performed to develop
the patientrsquos treatment plan electronically in
3 dimensions
bullTransfer of the plan to the patient at the
time of surgery can be accomplished by
production of the computer generated
three-dimensional stereotactic surgical
templates
Recent advances in
Computed Tomography(CT)
Microtomograph
Modification of CT it is specially useful in acquiring serial sections of bone
implant interface
Multi slice helical CT
The helical CT scan takes continuous pictures of the body in a rapid spiral motion
so that there are no gaps in the pictures collected
Recent Advances
in Implant Design
Mini implants
Mini dental implants (MDIs) are small diameter dental implants
Are sometimes referred to as SDIs (small diameter implants) as
well as NDIs (narrow body implants)
Diameter 18mm to 29mm (less than 3mm)
Various lengths 10 13 15 amp 18 mmrsquos
The MDI are available with either an O-ball head for use with
removable or fixed dentures or a square head for fixed prostheses or
retrofitting a poorly adapted partial denture
The body connects the tip with the prosthetic head and can be a
parallel sided cylinder or a progressively tapered cone
A small pilot bit is used to create the opening for the implant to be
threaded into the bone
The definitive implant supported crowns are usually delivered
within 2 weeks of surgery
Advantages
Immediate loading
Can be inserted in minimal tissues without relying on grafting
techniques
Minimally invasive procedure
One-stage denture stabilization
Does not require osteotomy
Cost-effective
Can be placed with a simple technique in patients with ridge too
narrow for conventional implants
Narrow-diameter implants Are they a predictable
treatment option A literature review
Joseacute-Luis Sierra-Saacutenchez Med Oral Patol Oral Cir Bucal 2014
Jan 119 (1)e74-81
The review included
Four randomized clinical trials
Ten prospective studies
Seven retrospective studies
The follow-up periods -12 months to 12 years
Total of 1607 patients
The patient age - 13 to 87 years
2980 implants
The recorded implant survival rates were above 90 in all the
studies Six studies published a survival rate of 100 at the end of
the follow-up period
The lowest survival rate (909) corresponded to the study
published by Barter et al
58 failures (implant loss) were recorded out of a total of 2980
implants
A larger number of failures were recorded with implants measuring
le 13 mm in length
Nineteen studies measured changes in peri-implant bone height
after implant loading 0065 mm the first year to 174 mm after a
follow-up period of 10 years
Araujo published a retrospective study on 33 mm implants placed
in posterior areas and rehabilitated following an immediate loading
protocol
Implant survival rate was 955 after 9 years of follow-up
That same year Degidi et al published a study comparing delayed
and immediate loading in narrow-diameter implants placed in both
anterior and posterior zones
Survival rate was 994 after a mean follow-up of 20 months
TRANSITIONAL IMPLANTS
Diameter ranges -18 to 28 mm
Length -7mm to 14mm
Fabricated with pure titanium in a single body with treated
surface
Primary function is to absorb masticatory stress during healing
phase
They should be placed at least 15 mm from adjacent teeth and
the distance between any transitional implant and a definitive
implant must be at least 15-2 mm
The abutment head generally has a 5 degree taper which makes it
optimal for retention of cement retained prostheses
Only one drill a 15 mm or 2 mm twist drill is required for
placement of the implants
Advantages
Provisionalisation of fully and partially edentulous jaws
Undisturbed healing of bone grafts
Effective way to generate aesthetic transitional appliances
Allows evaluation of phonetics and function
Cost effective
One ndash Piece Implants
The implant is machined from a piece of titanium that
incorporates both the implant body and an integral fixed abutment
in a single component
3 diameters -35 43 and 5 mm
4 lengths -10 13 15 and 16 mm
Clinical and radiographic evaluation of one-piece implants
used for immediate function
Jack a Hahn journal of oral implantology vol 33(3)2007
The aim of the present research was to evaluate the radiographic
outcome of a 1-piece implant when used for immediate function in
an ordinary patient pool
Forty-seven NobelDirect and NobelPerfect 1-piece implants
(Nobel Biocare Goumlteborg Sweden) were placed in maxillae and
mandibles
In this study 1 of the 47 implants had to be removed resulting in a
cumulative implant survival rate of 979 throughout the follow-up
period
The mean marginal bone level relative to the reference point after
1 year of loading (078 - 160 mm) as well as after 2 and 3 years of
loading was located above the first implant thread
In this study a bone level 2 mm apical to the reference point after
1 year of loading was observed at 2 implants (6)
The 1-piece implant design enables undisturbed healing
of the peri-implant soft tissue and avoids disruption of the
soft tissue seal when placing the definitive prosthetic
restoration
Annibali et al reported a series of patients treated
consecutively for first molar replacement according to
Immediate = group 1
Early = group 2
Late = Group 3
The implant survival rate
917 for early implants
950 for immediate post-extraction implants
100 for implants placed in healed sites
Short Dental Implants
A dental implant with length of 7 mm or less (Friberg et al 2000)
Any implant under 10 mm in length referred to as a lsquolsquoshortrsquorsquo
implant (Griffin TJ Cheung WS 2004)
A device with an intra-bony length of 8 mm or less (Renouard
and Nisand 2006)
Indication
Atropic Jaw
Proximity to vital structure
Single crowns
Overdentures
Advantages
1 Bone grafting for height often unnecessary
2 Less money pain and time prior to restoration of the implant
3 Simplified bone surgery
4 Implant insertion easier
Goodacre et al in 2003 reviewed
2754 implants - lt10 mm
3015 implants - gt10 mm in length
The failure rate of implants 10 mm or less was 10 compared
to a 3 failure rate of implants longer than 10 mm
Ivanoff et al in 1999 found an 8-mm-long 5-mm-diameter
implant failed 25 of the time in the maxilla and 33 of the
time in the mandible On the other hand the 10-mm and 12-
mm implants that were 5 mm in diameter reported no
mandibular failure and a 10 failure in the maxilla
Misch CE Short Dental Implants A Literature Review and Rationale for Use Dent Today 2005 Aug24(8)64-6 68
On the other hand a retrospective report by Misch et al was compiled
from 2 private offices using a square thread implant body design
(BioHorizons) rather than a v-shaped thread as primarily reported in the
previous literature
During a 3-year period 126 patients received implants less than 10 mm
long
Of the 437 implants there were 3 implant failures in the posterior
mandible and 1 failure in the posterior maxilla (99 survival)
All these failures were implants 9 mm long and 4 mm in diameter
Advances in Implant materials
Previously implants had macro-irregularities like macroscopic
threads fenestrations pores grooves steps threads or other
surface irregularities that were visible
However difficulty in achieving initial stability post implantation
relative motion adverse interfacial bone remodelling all lead to
search for improvement of the surface quality of a titanium dental
implant
BLASTING
Blasting -aluminium oxide titanium oxide and calcium phosphate
with particle size ranging from small medium to large (150- 350
microm)
Blasting a smooth Ti surface with Al2 O3 particles of 25 microm 75 microm
or 250 microm produces surfaces with roughness values of 116 to 120
143 and 194 to 220 respectively
A series of investigations have demonstrated a firmer bone
fixation of the implant with an average surface roughness (sa) of 1-
15microm than those of smoother implants with an average surface
roughness of 06microm
Blasting and Acid Etching
Acid etching can be done by using an HCL H2 SO4 mixture or by
pickling in 2 HF10HNO3 These processes leave pits and craters
Alumina or TiO2 for blasting the surface
Small - 25μm
large grit -025-05mm
medium grit - 250-500μm
Sand blasted and acid etched surfaces have a hydrophobic surface
The etching leads to the formation of Titanium hydrides and the
replacement of hydride by oxygen results in the slow transformation of
the implant surface resulting in nanometre sized particles of titanium on
the surface which helps in protein adhesion on implant surface
Dual acid etching with HCl and H2SO4 heated above 100ᴼC has
produced surface topography able to attach to fibrin scaffold and
promote adhesion of osteogenic cells
Sand blasting and etching can increase the rate and amount of the
bone formation
Flouride Surface Treatments
This treatment enhances osseointegration and osteoblastic
differentitation with increased expression of Cbfa1 osterix and
bone sialoprotein
Fluoridated rough implants also withstood greater push-out
forces and showed a significantly higher removal torque than
control implants
However detrimental effect of F on the corrosion resistance of
titanium and titanium alloys has been extensively reported
Anodized Surface Implants
Anodized surface implants are implants which are placed as anodes
in galvanic cells with phosphoric acid as the electrolyte and current is
passed through them ndash also ca ldquoTiunite surfacerdquo
The surface oxides grow from the native state of 5nm to
approximately 10000nm
The sa of TiUnite is reported to be 11microm and its sdr 37
Anodic oxidation results in the growth of a native titanium oxide
layer and a porous topography with the bone formation occurring
directly on the moderately rough oxidized surface
Clinical and Radiographic Evaluation of Braringnemark Implants with an
Anodized Surface following Seven-to-Eight Years of Functional Loading
David Gelb Bradley McaAllister et al Int J Dent 2013 2013 583567
The aim of this study was to evaluate the clinical and
radiographic long-term outcomes of dental implants with an
anodized TiUnite surface placed in routine clinical practice
38 single prosthesis
22 FPDs
80 implants in maxilla
27 in mandible
Mean marginal bone level change-149 plusmn 103 mm
907 of cases- no visible plaque93 -visible plaque
No prosthetic complication
Calandriello evaluated immediately placed anodized
implants in 33 patients and found a mean marginal bone
loss of 117thinspmm after 5 years
Friberg and Jemt compared 280 TiUnite implants to 110
machined implants in 111 patients and found marginal
bone loss after 5 years to be 075 and 06thinspmm respectively
with no significant difference between the two types of
implants
Laser etching and Micro Arc Oxidation
After the implants are ultrasonically cleaned they are laser etched
by using an NdYAG laser at a power of 50kw frequency of 75khz
and 164A current
They are then processed in an electrolyte solution with 35
glyceroposphate disodium salt pentahydrate and 12 calcium
acetate monohydrate by microarc oxidation (voltage 350v
frequency 800hz) for 15 seconds
Microarc oxidation produces a titania film with a porous structure
and micropores of 1-5microm
The mechanism of osseointegration of the oxidized implants has
been shown to be mechanical interlocking and biochemical
bonding
Surface coating Ti Plasma Spray
Porous rough Ti surface have been fabricated by plasma
spraying a Ti powder form of molten droplets at high temperature
at temperature in order of 15000C at 600ms
The Ti plasma spray after solidification often provides 004 ndash 005
mm thickness
Ti A spray has been reported to increase the surface area of bone
to implant interface (as much as 600) and stimulate adhesion
osteogenesis
Advantages
Enhance attachment by increasing ionic interactions
Increased load bearing capability by 25-30
Increased tensile strength through ingrowth of bony tissues into 3D feature
Disadvantages
Cracking and scaling of coating because of stresses produced by elevated temprature processing
Risk of accumulation of abraded material in the interface zone during implantation of TPS
Hydroxyapatite coatings
Hydroxyapatite [Ca10(PO4)6OH]2 coating was brought to the
dental profession by DeGroot
HA forms a strong chemical bond with bone due to the presence
of free calcium and phosphate compounds at the implant surface
The HA coating consists of amorphous and crystalline forms with
a large density of cracks
The top 1-2 microm of the HA layer being amorphous while the rest
of the crystalline layer is hexagonally packed
Indicated Fresh extraction sites
Newly grafted sites
Advantages
1 Protection of surrounding bone against metal ion release from the
substrate
2 Reported chemical bonding between HA and living bone-intimate
contact-biointegration
3 Partial dissolution of HA makes surrounding fluid rich in calcium
and phosphate ions which trigger cellular differentiation and bone
formation
Disadvantages
Induction of impurities due to thermal decomposition during
processing- affecting long term clinical fixation
Dissolution of HA at lower pH
HA coating on the implant surface (50-70microm) by various methods
1 Plasma spraying
2 The vacuum deposition technique(ion beam sputtering radiofrequency
sputtering)
3 The sol gel and dip coating method
4 Electrolytic process
Nanotitania coatings
Nanotitania coatings were prepared by using the sol-gel
technique
Nanotitania implants had an increased feature density and a large
feature coverage area as compared to the nano-HA implants
This could present more binding sites for the protein cell
attachment and for increased bone contact
he Nanotitania implants exhibited an ordered arrangement
forming a homogenous layer on underlying topography
Biologically active drugs incorporated dental
implants
Bisphosphonates Bisphosphate-loaded implant surfaces have
been reported to improve implant osseointegration
Simvastatin
Simvastatin could induce the expression of bone morphogenetic
protein (BMP) mRNA that might promote bone formation and
increase bone mineral density
Gentamycin along with the layer of HA can be coated onto the
implant surface which may act as a local prophylactic agent along
with the systemic antibiotics in dental implant surgery
Biochemical Methods
of the Surface
Modifications
Biochemical Methods of the Surface
Modifications
Their goal is to immobilize proteins enzymes or peptides on
biomaterials for the purpose of inducing specific cell and tissue
responses
1 One approach uses cell-adhesion molecules like fibronectin
vitronectin Type I collagen osteogenin and bone sialoprotein
2 The second approach uses biomolecules with osteotropic
effects which range from mitogenicity (interleukin growth
factor-I FGF-2 platelet derived growth factor ndashBB) to the
increasing activity of the bone cells which enhances the
collagen synthesis for osteoinduction
Zirconia implants
Zirconia (Zr02) is a ceramic material used in implantology because
Biocompatibility(bio inert)
Esthetics (because its colour is similar to the teeth) and
Mechanical properties which are better than alumina
High resistance to corrosion flexion and fracture
Contact with bone and soft tissue similar to that observed in
titanium implants
It can be used to produce a entire implant or as a coating
Advantages of Zirconia Dental Implants
No dark colour of the metal showing through the gums
No corrosion of the zirconia as with titanium
No piezo-electric currents between dissimilar metal in
the mouth
It is thermally non-conductive
Greater BIC (Bone ndash Implant Contact)
20 more bone apposition than titanium implants
Zeynep Ouml zkurt Zirconia Dental Implants A Literature Review Journal of Oral Implantology Vol 37(3)2011
RTQ (removal torque testing) Gahlert et al evaluated the RTQ values of
machined zirconia implants sandblasted zirconia implants and SLA titanium
implants The mean RTQ for machined zirconia implants was 259 Ncm the
mean RTQ for zirconia rough implants was 405 Ncm and the mean RTQ for
SLA titanium implants was 1052 Ncm
Fracture strength within clinically acceptable limits
Stress analysis Kohal et al observed the stress distribution patterns of
zirconia implants (ReImplant) which were found to have low well distributed
and similar stress distribution compared with titanium implants
PEEK implants (poly etheretherketone)
These implants are available in three fundamentally different
designs
TAU Diameter -48 mm lengths 10 125 15 mm
immediate loading possible
Low density bone
THETA Similar to TAU but D1 bone
IOTA It is a 3mm diameter implant (10 and 12 mm)
used in narrow ridges
Advantages
Good strengthfracture resistance and bioinertness
Promotes human oseteoblast cell growth
Disadvantages
Faintly radiopaque ndashdifficult for post-op evaluation
Lengths and diameters range is restricted
Advances in
commercially
available implant
systems
LASER- LOK TECHNOLOGY
Unique surface characteristics
Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using
laser ablation technology
Extremely consistent microchannels that are optimally
sized to attach and organize both osteoblasts and
fibroblasts
Includes a repeating nanostructure that maximizes
surface area and enables cell pseudopodia and collagen
microfibrils to interdigitate with the Laser-Lok surface
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Introduction
The science of implantology is highly dynamic Ever since its
introduction into the field of dentistry by Dr Branemark it has
undergone numerous modifications and improvements
With each improvement and advancement made implantology
has proved to be a boon in disguise to the society
Contents
Advances in Diagnostic imaging
Recent advances in Implant design
Advances in Implant materials
Advances in commercially available implant systems
Software simplifying treatment planning
Recent advances in Implant Abutments
Implant -Abutment connection
New concepts in Implant rehabilitation
Conclusion
References
Advances in
Diagnostic
Imaging
Imaging
Phase 1 Pre-prosthetic implant
imaging
Phase 2 Surgical and interventional implant imaging
Phase 3 Post-prosthetic implant
imaging
Determines the
bull Quantity quality and
angulation of bone
bullRelationship of critical
structures to prospective
implant sites
bull The presence or absence of
disease at the proposed
surgical sites
Evaluates the
surgical sites during
and immediately
after surgery
Evaluates the long-term
change
bull Crestal bone levels around
each implant
bull Changes in mineralization or
bone volume
ZONOGRAPHY
A modification of the panoramic x-ray machine for making
cross sectional images of the jaws
The tomographic layer is approximately 5mm
For appreciation of spatial relationship between the critical
structures and the implant siteLimitations
bullTomographic layers relatively thick
bullAdjacent structures blurring and superimposition
bullNot useful for determining the differences in
bone density or for identifying disease at implant
site
Tomography
Tomography is the generic name formed by the greek
words lsquotomorsquo(slice) and lsquographyrsquo(picture)
Enables visualization of a section of patientrsquos anatomy by
blurring other regions above and below the site of interest
For dental implant patients high quality complex motion
tomography is required
Computed tomography (CT)
CT was invented by Sir Godfrey Hounsfield and was introduced in
1972
Computed tomography (CT) is a digital and mathematical imaging
technique that creates tomographic sections and allows soft tissues
and hard tissues to be visualized simultaneously
Ideally tomographic sections spaced 1 to 2 mm enable evaluation of
implant site and 3D appearance of alveolus
With latest CT scanners images with sectional thickness of 025 mm
can be obtained
The advantages of CT based systems are
Uniform magnification
High contrast image with well-defined image layer free of
blurring
Easier identification of bone grafts or hydroxyappatite materials
used to augment maxillary bone in sinus region
Multiplanar views
Three-dimensional reconstruction
Simultaneous study of multiple implant sites
Availability of soft tissue for image analysis
Disadvantages
Limited availability of reconstructive software
Higher dose of radiation
Lack of understanding of dentists
Lack of usefulness for implant interface follow-up because of
metallic streak artifacts
Expense
Recent advances in Computed Tomography(CT)
Tuned Aperture CT (TACT)
Tuned aperture computed tomography (TACT) by Webber is a
relatively simple faster method for reconstructing tomographic
images
It is based on the concept of tomo-synthesis and optical-aperture
theory
TACT uses 2-D periapical radiographs acquired from different
projection angles as base images and permits retrospective
generation of longitudinal tomographic slices (TACT-S) lining up in
the Z axis of the area of interest
The overall radiation dose of TACT is not greater than 1 to 2 times
that of a conventional periapical X-ray film
The resolution is stated to be similar with 2-D radiographs
Artefacts associated with CT such as starburst patterns seen with
metallic restorations do not exist with TACT
The big conceptCone Bean Computed Tomography
Cone Beam Computed Tomography
Fan beam Cone beam
Software programs incorporating sophisticated
algorithms including back-filtered projection are applied
to these image data to generate a 3D volumetric data set
which can be used to provide primary reconstruction
images in 3 orthogonal planes (axial sagittal and coronal)
CBCT is devoted to maxillofacial area to scan and
visualize jaw bone lesions especially cancellous bone
It gives all the information of a CT but at 18th the
radiation dose and at a lower cost
CBCT is categorized into large medium and limited volume units based on the size
of their field of view (FOV)
Large (FOV)
bull 15-23 cm
bull Maxillofacial trauma
bull Orthodontic use
bull TMJ diseases
Medium FOV
bull 10-15 cm
bull Mandibulo-maxillary imaging
bull Pre-implant planning
bull Pathology
Small FOV
bull lt 10 cm
bull Endodontic applications
Advantages of CBCT
X-ray beam limitation
Image accuracy
Rapid scan time 10ndash70 seconds
Software can be made available to the user
Dose reduction Effective dose is 98 smaller than conventional CT
Reduced image artifact
Interactive computed tomography(ICT)
bullThis technique enables transfer of the imaging study to the
clinician as a computer filehellip
bullThe clinicianrsquos computer becomes a diagnostic radiologic
workstation with tools
bullAn important feature of ICT is that the clinician and radiologist can
perform ldquoelectronic surgeryrdquo (ES)
bull With an appropriately designed diagnostic
template ES can be performed to develop
the patientrsquos treatment plan electronically in
3 dimensions
bullTransfer of the plan to the patient at the
time of surgery can be accomplished by
production of the computer generated
three-dimensional stereotactic surgical
templates
Recent advances in
Computed Tomography(CT)
Microtomograph
Modification of CT it is specially useful in acquiring serial sections of bone
implant interface
Multi slice helical CT
The helical CT scan takes continuous pictures of the body in a rapid spiral motion
so that there are no gaps in the pictures collected
Recent Advances
in Implant Design
Mini implants
Mini dental implants (MDIs) are small diameter dental implants
Are sometimes referred to as SDIs (small diameter implants) as
well as NDIs (narrow body implants)
Diameter 18mm to 29mm (less than 3mm)
Various lengths 10 13 15 amp 18 mmrsquos
The MDI are available with either an O-ball head for use with
removable or fixed dentures or a square head for fixed prostheses or
retrofitting a poorly adapted partial denture
The body connects the tip with the prosthetic head and can be a
parallel sided cylinder or a progressively tapered cone
A small pilot bit is used to create the opening for the implant to be
threaded into the bone
The definitive implant supported crowns are usually delivered
within 2 weeks of surgery
Advantages
Immediate loading
Can be inserted in minimal tissues without relying on grafting
techniques
Minimally invasive procedure
One-stage denture stabilization
Does not require osteotomy
Cost-effective
Can be placed with a simple technique in patients with ridge too
narrow for conventional implants
Narrow-diameter implants Are they a predictable
treatment option A literature review
Joseacute-Luis Sierra-Saacutenchez Med Oral Patol Oral Cir Bucal 2014
Jan 119 (1)e74-81
The review included
Four randomized clinical trials
Ten prospective studies
Seven retrospective studies
The follow-up periods -12 months to 12 years
Total of 1607 patients
The patient age - 13 to 87 years
2980 implants
The recorded implant survival rates were above 90 in all the
studies Six studies published a survival rate of 100 at the end of
the follow-up period
The lowest survival rate (909) corresponded to the study
published by Barter et al
58 failures (implant loss) were recorded out of a total of 2980
implants
A larger number of failures were recorded with implants measuring
le 13 mm in length
Nineteen studies measured changes in peri-implant bone height
after implant loading 0065 mm the first year to 174 mm after a
follow-up period of 10 years
Araujo published a retrospective study on 33 mm implants placed
in posterior areas and rehabilitated following an immediate loading
protocol
Implant survival rate was 955 after 9 years of follow-up
That same year Degidi et al published a study comparing delayed
and immediate loading in narrow-diameter implants placed in both
anterior and posterior zones
Survival rate was 994 after a mean follow-up of 20 months
TRANSITIONAL IMPLANTS
Diameter ranges -18 to 28 mm
Length -7mm to 14mm
Fabricated with pure titanium in a single body with treated
surface
Primary function is to absorb masticatory stress during healing
phase
They should be placed at least 15 mm from adjacent teeth and
the distance between any transitional implant and a definitive
implant must be at least 15-2 mm
The abutment head generally has a 5 degree taper which makes it
optimal for retention of cement retained prostheses
Only one drill a 15 mm or 2 mm twist drill is required for
placement of the implants
Advantages
Provisionalisation of fully and partially edentulous jaws
Undisturbed healing of bone grafts
Effective way to generate aesthetic transitional appliances
Allows evaluation of phonetics and function
Cost effective
One ndash Piece Implants
The implant is machined from a piece of titanium that
incorporates both the implant body and an integral fixed abutment
in a single component
3 diameters -35 43 and 5 mm
4 lengths -10 13 15 and 16 mm
Clinical and radiographic evaluation of one-piece implants
used for immediate function
Jack a Hahn journal of oral implantology vol 33(3)2007
The aim of the present research was to evaluate the radiographic
outcome of a 1-piece implant when used for immediate function in
an ordinary patient pool
Forty-seven NobelDirect and NobelPerfect 1-piece implants
(Nobel Biocare Goumlteborg Sweden) were placed in maxillae and
mandibles
In this study 1 of the 47 implants had to be removed resulting in a
cumulative implant survival rate of 979 throughout the follow-up
period
The mean marginal bone level relative to the reference point after
1 year of loading (078 - 160 mm) as well as after 2 and 3 years of
loading was located above the first implant thread
In this study a bone level 2 mm apical to the reference point after
1 year of loading was observed at 2 implants (6)
The 1-piece implant design enables undisturbed healing
of the peri-implant soft tissue and avoids disruption of the
soft tissue seal when placing the definitive prosthetic
restoration
Annibali et al reported a series of patients treated
consecutively for first molar replacement according to
Immediate = group 1
Early = group 2
Late = Group 3
The implant survival rate
917 for early implants
950 for immediate post-extraction implants
100 for implants placed in healed sites
Short Dental Implants
A dental implant with length of 7 mm or less (Friberg et al 2000)
Any implant under 10 mm in length referred to as a lsquolsquoshortrsquorsquo
implant (Griffin TJ Cheung WS 2004)
A device with an intra-bony length of 8 mm or less (Renouard
and Nisand 2006)
Indication
Atropic Jaw
Proximity to vital structure
Single crowns
Overdentures
Advantages
1 Bone grafting for height often unnecessary
2 Less money pain and time prior to restoration of the implant
3 Simplified bone surgery
4 Implant insertion easier
Goodacre et al in 2003 reviewed
2754 implants - lt10 mm
3015 implants - gt10 mm in length
The failure rate of implants 10 mm or less was 10 compared
to a 3 failure rate of implants longer than 10 mm
Ivanoff et al in 1999 found an 8-mm-long 5-mm-diameter
implant failed 25 of the time in the maxilla and 33 of the
time in the mandible On the other hand the 10-mm and 12-
mm implants that were 5 mm in diameter reported no
mandibular failure and a 10 failure in the maxilla
Misch CE Short Dental Implants A Literature Review and Rationale for Use Dent Today 2005 Aug24(8)64-6 68
On the other hand a retrospective report by Misch et al was compiled
from 2 private offices using a square thread implant body design
(BioHorizons) rather than a v-shaped thread as primarily reported in the
previous literature
During a 3-year period 126 patients received implants less than 10 mm
long
Of the 437 implants there were 3 implant failures in the posterior
mandible and 1 failure in the posterior maxilla (99 survival)
All these failures were implants 9 mm long and 4 mm in diameter
Advances in Implant materials
Previously implants had macro-irregularities like macroscopic
threads fenestrations pores grooves steps threads or other
surface irregularities that were visible
However difficulty in achieving initial stability post implantation
relative motion adverse interfacial bone remodelling all lead to
search for improvement of the surface quality of a titanium dental
implant
BLASTING
Blasting -aluminium oxide titanium oxide and calcium phosphate
with particle size ranging from small medium to large (150- 350
microm)
Blasting a smooth Ti surface with Al2 O3 particles of 25 microm 75 microm
or 250 microm produces surfaces with roughness values of 116 to 120
143 and 194 to 220 respectively
A series of investigations have demonstrated a firmer bone
fixation of the implant with an average surface roughness (sa) of 1-
15microm than those of smoother implants with an average surface
roughness of 06microm
Blasting and Acid Etching
Acid etching can be done by using an HCL H2 SO4 mixture or by
pickling in 2 HF10HNO3 These processes leave pits and craters
Alumina or TiO2 for blasting the surface
Small - 25μm
large grit -025-05mm
medium grit - 250-500μm
Sand blasted and acid etched surfaces have a hydrophobic surface
The etching leads to the formation of Titanium hydrides and the
replacement of hydride by oxygen results in the slow transformation of
the implant surface resulting in nanometre sized particles of titanium on
the surface which helps in protein adhesion on implant surface
Dual acid etching with HCl and H2SO4 heated above 100ᴼC has
produced surface topography able to attach to fibrin scaffold and
promote adhesion of osteogenic cells
Sand blasting and etching can increase the rate and amount of the
bone formation
Flouride Surface Treatments
This treatment enhances osseointegration and osteoblastic
differentitation with increased expression of Cbfa1 osterix and
bone sialoprotein
Fluoridated rough implants also withstood greater push-out
forces and showed a significantly higher removal torque than
control implants
However detrimental effect of F on the corrosion resistance of
titanium and titanium alloys has been extensively reported
Anodized Surface Implants
Anodized surface implants are implants which are placed as anodes
in galvanic cells with phosphoric acid as the electrolyte and current is
passed through them ndash also ca ldquoTiunite surfacerdquo
The surface oxides grow from the native state of 5nm to
approximately 10000nm
The sa of TiUnite is reported to be 11microm and its sdr 37
Anodic oxidation results in the growth of a native titanium oxide
layer and a porous topography with the bone formation occurring
directly on the moderately rough oxidized surface
Clinical and Radiographic Evaluation of Braringnemark Implants with an
Anodized Surface following Seven-to-Eight Years of Functional Loading
David Gelb Bradley McaAllister et al Int J Dent 2013 2013 583567
The aim of this study was to evaluate the clinical and
radiographic long-term outcomes of dental implants with an
anodized TiUnite surface placed in routine clinical practice
38 single prosthesis
22 FPDs
80 implants in maxilla
27 in mandible
Mean marginal bone level change-149 plusmn 103 mm
907 of cases- no visible plaque93 -visible plaque
No prosthetic complication
Calandriello evaluated immediately placed anodized
implants in 33 patients and found a mean marginal bone
loss of 117thinspmm after 5 years
Friberg and Jemt compared 280 TiUnite implants to 110
machined implants in 111 patients and found marginal
bone loss after 5 years to be 075 and 06thinspmm respectively
with no significant difference between the two types of
implants
Laser etching and Micro Arc Oxidation
After the implants are ultrasonically cleaned they are laser etched
by using an NdYAG laser at a power of 50kw frequency of 75khz
and 164A current
They are then processed in an electrolyte solution with 35
glyceroposphate disodium salt pentahydrate and 12 calcium
acetate monohydrate by microarc oxidation (voltage 350v
frequency 800hz) for 15 seconds
Microarc oxidation produces a titania film with a porous structure
and micropores of 1-5microm
The mechanism of osseointegration of the oxidized implants has
been shown to be mechanical interlocking and biochemical
bonding
Surface coating Ti Plasma Spray
Porous rough Ti surface have been fabricated by plasma
spraying a Ti powder form of molten droplets at high temperature
at temperature in order of 15000C at 600ms
The Ti plasma spray after solidification often provides 004 ndash 005
mm thickness
Ti A spray has been reported to increase the surface area of bone
to implant interface (as much as 600) and stimulate adhesion
osteogenesis
Advantages
Enhance attachment by increasing ionic interactions
Increased load bearing capability by 25-30
Increased tensile strength through ingrowth of bony tissues into 3D feature
Disadvantages
Cracking and scaling of coating because of stresses produced by elevated temprature processing
Risk of accumulation of abraded material in the interface zone during implantation of TPS
Hydroxyapatite coatings
Hydroxyapatite [Ca10(PO4)6OH]2 coating was brought to the
dental profession by DeGroot
HA forms a strong chemical bond with bone due to the presence
of free calcium and phosphate compounds at the implant surface
The HA coating consists of amorphous and crystalline forms with
a large density of cracks
The top 1-2 microm of the HA layer being amorphous while the rest
of the crystalline layer is hexagonally packed
Indicated Fresh extraction sites
Newly grafted sites
Advantages
1 Protection of surrounding bone against metal ion release from the
substrate
2 Reported chemical bonding between HA and living bone-intimate
contact-biointegration
3 Partial dissolution of HA makes surrounding fluid rich in calcium
and phosphate ions which trigger cellular differentiation and bone
formation
Disadvantages
Induction of impurities due to thermal decomposition during
processing- affecting long term clinical fixation
Dissolution of HA at lower pH
HA coating on the implant surface (50-70microm) by various methods
1 Plasma spraying
2 The vacuum deposition technique(ion beam sputtering radiofrequency
sputtering)
3 The sol gel and dip coating method
4 Electrolytic process
Nanotitania coatings
Nanotitania coatings were prepared by using the sol-gel
technique
Nanotitania implants had an increased feature density and a large
feature coverage area as compared to the nano-HA implants
This could present more binding sites for the protein cell
attachment and for increased bone contact
he Nanotitania implants exhibited an ordered arrangement
forming a homogenous layer on underlying topography
Biologically active drugs incorporated dental
implants
Bisphosphonates Bisphosphate-loaded implant surfaces have
been reported to improve implant osseointegration
Simvastatin
Simvastatin could induce the expression of bone morphogenetic
protein (BMP) mRNA that might promote bone formation and
increase bone mineral density
Gentamycin along with the layer of HA can be coated onto the
implant surface which may act as a local prophylactic agent along
with the systemic antibiotics in dental implant surgery
Biochemical Methods
of the Surface
Modifications
Biochemical Methods of the Surface
Modifications
Their goal is to immobilize proteins enzymes or peptides on
biomaterials for the purpose of inducing specific cell and tissue
responses
1 One approach uses cell-adhesion molecules like fibronectin
vitronectin Type I collagen osteogenin and bone sialoprotein
2 The second approach uses biomolecules with osteotropic
effects which range from mitogenicity (interleukin growth
factor-I FGF-2 platelet derived growth factor ndashBB) to the
increasing activity of the bone cells which enhances the
collagen synthesis for osteoinduction
Zirconia implants
Zirconia (Zr02) is a ceramic material used in implantology because
Biocompatibility(bio inert)
Esthetics (because its colour is similar to the teeth) and
Mechanical properties which are better than alumina
High resistance to corrosion flexion and fracture
Contact with bone and soft tissue similar to that observed in
titanium implants
It can be used to produce a entire implant or as a coating
Advantages of Zirconia Dental Implants
No dark colour of the metal showing through the gums
No corrosion of the zirconia as with titanium
No piezo-electric currents between dissimilar metal in
the mouth
It is thermally non-conductive
Greater BIC (Bone ndash Implant Contact)
20 more bone apposition than titanium implants
Zeynep Ouml zkurt Zirconia Dental Implants A Literature Review Journal of Oral Implantology Vol 37(3)2011
RTQ (removal torque testing) Gahlert et al evaluated the RTQ values of
machined zirconia implants sandblasted zirconia implants and SLA titanium
implants The mean RTQ for machined zirconia implants was 259 Ncm the
mean RTQ for zirconia rough implants was 405 Ncm and the mean RTQ for
SLA titanium implants was 1052 Ncm
Fracture strength within clinically acceptable limits
Stress analysis Kohal et al observed the stress distribution patterns of
zirconia implants (ReImplant) which were found to have low well distributed
and similar stress distribution compared with titanium implants
PEEK implants (poly etheretherketone)
These implants are available in three fundamentally different
designs
TAU Diameter -48 mm lengths 10 125 15 mm
immediate loading possible
Low density bone
THETA Similar to TAU but D1 bone
IOTA It is a 3mm diameter implant (10 and 12 mm)
used in narrow ridges
Advantages
Good strengthfracture resistance and bioinertness
Promotes human oseteoblast cell growth
Disadvantages
Faintly radiopaque ndashdifficult for post-op evaluation
Lengths and diameters range is restricted
Advances in
commercially
available implant
systems
LASER- LOK TECHNOLOGY
Unique surface characteristics
Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using
laser ablation technology
Extremely consistent microchannels that are optimally
sized to attach and organize both osteoblasts and
fibroblasts
Includes a repeating nanostructure that maximizes
surface area and enables cell pseudopodia and collagen
microfibrils to interdigitate with the Laser-Lok surface
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Contents
Advances in Diagnostic imaging
Recent advances in Implant design
Advances in Implant materials
Advances in commercially available implant systems
Software simplifying treatment planning
Recent advances in Implant Abutments
Implant -Abutment connection
New concepts in Implant rehabilitation
Conclusion
References
Advances in
Diagnostic
Imaging
Imaging
Phase 1 Pre-prosthetic implant
imaging
Phase 2 Surgical and interventional implant imaging
Phase 3 Post-prosthetic implant
imaging
Determines the
bull Quantity quality and
angulation of bone
bullRelationship of critical
structures to prospective
implant sites
bull The presence or absence of
disease at the proposed
surgical sites
Evaluates the
surgical sites during
and immediately
after surgery
Evaluates the long-term
change
bull Crestal bone levels around
each implant
bull Changes in mineralization or
bone volume
ZONOGRAPHY
A modification of the panoramic x-ray machine for making
cross sectional images of the jaws
The tomographic layer is approximately 5mm
For appreciation of spatial relationship between the critical
structures and the implant siteLimitations
bullTomographic layers relatively thick
bullAdjacent structures blurring and superimposition
bullNot useful for determining the differences in
bone density or for identifying disease at implant
site
Tomography
Tomography is the generic name formed by the greek
words lsquotomorsquo(slice) and lsquographyrsquo(picture)
Enables visualization of a section of patientrsquos anatomy by
blurring other regions above and below the site of interest
For dental implant patients high quality complex motion
tomography is required
Computed tomography (CT)
CT was invented by Sir Godfrey Hounsfield and was introduced in
1972
Computed tomography (CT) is a digital and mathematical imaging
technique that creates tomographic sections and allows soft tissues
and hard tissues to be visualized simultaneously
Ideally tomographic sections spaced 1 to 2 mm enable evaluation of
implant site and 3D appearance of alveolus
With latest CT scanners images with sectional thickness of 025 mm
can be obtained
The advantages of CT based systems are
Uniform magnification
High contrast image with well-defined image layer free of
blurring
Easier identification of bone grafts or hydroxyappatite materials
used to augment maxillary bone in sinus region
Multiplanar views
Three-dimensional reconstruction
Simultaneous study of multiple implant sites
Availability of soft tissue for image analysis
Disadvantages
Limited availability of reconstructive software
Higher dose of radiation
Lack of understanding of dentists
Lack of usefulness for implant interface follow-up because of
metallic streak artifacts
Expense
Recent advances in Computed Tomography(CT)
Tuned Aperture CT (TACT)
Tuned aperture computed tomography (TACT) by Webber is a
relatively simple faster method for reconstructing tomographic
images
It is based on the concept of tomo-synthesis and optical-aperture
theory
TACT uses 2-D periapical radiographs acquired from different
projection angles as base images and permits retrospective
generation of longitudinal tomographic slices (TACT-S) lining up in
the Z axis of the area of interest
The overall radiation dose of TACT is not greater than 1 to 2 times
that of a conventional periapical X-ray film
The resolution is stated to be similar with 2-D radiographs
Artefacts associated with CT such as starburst patterns seen with
metallic restorations do not exist with TACT
The big conceptCone Bean Computed Tomography
Cone Beam Computed Tomography
Fan beam Cone beam
Software programs incorporating sophisticated
algorithms including back-filtered projection are applied
to these image data to generate a 3D volumetric data set
which can be used to provide primary reconstruction
images in 3 orthogonal planes (axial sagittal and coronal)
CBCT is devoted to maxillofacial area to scan and
visualize jaw bone lesions especially cancellous bone
It gives all the information of a CT but at 18th the
radiation dose and at a lower cost
CBCT is categorized into large medium and limited volume units based on the size
of their field of view (FOV)
Large (FOV)
bull 15-23 cm
bull Maxillofacial trauma
bull Orthodontic use
bull TMJ diseases
Medium FOV
bull 10-15 cm
bull Mandibulo-maxillary imaging
bull Pre-implant planning
bull Pathology
Small FOV
bull lt 10 cm
bull Endodontic applications
Advantages of CBCT
X-ray beam limitation
Image accuracy
Rapid scan time 10ndash70 seconds
Software can be made available to the user
Dose reduction Effective dose is 98 smaller than conventional CT
Reduced image artifact
Interactive computed tomography(ICT)
bullThis technique enables transfer of the imaging study to the
clinician as a computer filehellip
bullThe clinicianrsquos computer becomes a diagnostic radiologic
workstation with tools
bullAn important feature of ICT is that the clinician and radiologist can
perform ldquoelectronic surgeryrdquo (ES)
bull With an appropriately designed diagnostic
template ES can be performed to develop
the patientrsquos treatment plan electronically in
3 dimensions
bullTransfer of the plan to the patient at the
time of surgery can be accomplished by
production of the computer generated
three-dimensional stereotactic surgical
templates
Recent advances in
Computed Tomography(CT)
Microtomograph
Modification of CT it is specially useful in acquiring serial sections of bone
implant interface
Multi slice helical CT
The helical CT scan takes continuous pictures of the body in a rapid spiral motion
so that there are no gaps in the pictures collected
Recent Advances
in Implant Design
Mini implants
Mini dental implants (MDIs) are small diameter dental implants
Are sometimes referred to as SDIs (small diameter implants) as
well as NDIs (narrow body implants)
Diameter 18mm to 29mm (less than 3mm)
Various lengths 10 13 15 amp 18 mmrsquos
The MDI are available with either an O-ball head for use with
removable or fixed dentures or a square head for fixed prostheses or
retrofitting a poorly adapted partial denture
The body connects the tip with the prosthetic head and can be a
parallel sided cylinder or a progressively tapered cone
A small pilot bit is used to create the opening for the implant to be
threaded into the bone
The definitive implant supported crowns are usually delivered
within 2 weeks of surgery
Advantages
Immediate loading
Can be inserted in minimal tissues without relying on grafting
techniques
Minimally invasive procedure
One-stage denture stabilization
Does not require osteotomy
Cost-effective
Can be placed with a simple technique in patients with ridge too
narrow for conventional implants
Narrow-diameter implants Are they a predictable
treatment option A literature review
Joseacute-Luis Sierra-Saacutenchez Med Oral Patol Oral Cir Bucal 2014
Jan 119 (1)e74-81
The review included
Four randomized clinical trials
Ten prospective studies
Seven retrospective studies
The follow-up periods -12 months to 12 years
Total of 1607 patients
The patient age - 13 to 87 years
2980 implants
The recorded implant survival rates were above 90 in all the
studies Six studies published a survival rate of 100 at the end of
the follow-up period
The lowest survival rate (909) corresponded to the study
published by Barter et al
58 failures (implant loss) were recorded out of a total of 2980
implants
A larger number of failures were recorded with implants measuring
le 13 mm in length
Nineteen studies measured changes in peri-implant bone height
after implant loading 0065 mm the first year to 174 mm after a
follow-up period of 10 years
Araujo published a retrospective study on 33 mm implants placed
in posterior areas and rehabilitated following an immediate loading
protocol
Implant survival rate was 955 after 9 years of follow-up
That same year Degidi et al published a study comparing delayed
and immediate loading in narrow-diameter implants placed in both
anterior and posterior zones
Survival rate was 994 after a mean follow-up of 20 months
TRANSITIONAL IMPLANTS
Diameter ranges -18 to 28 mm
Length -7mm to 14mm
Fabricated with pure titanium in a single body with treated
surface
Primary function is to absorb masticatory stress during healing
phase
They should be placed at least 15 mm from adjacent teeth and
the distance between any transitional implant and a definitive
implant must be at least 15-2 mm
The abutment head generally has a 5 degree taper which makes it
optimal for retention of cement retained prostheses
Only one drill a 15 mm or 2 mm twist drill is required for
placement of the implants
Advantages
Provisionalisation of fully and partially edentulous jaws
Undisturbed healing of bone grafts
Effective way to generate aesthetic transitional appliances
Allows evaluation of phonetics and function
Cost effective
One ndash Piece Implants
The implant is machined from a piece of titanium that
incorporates both the implant body and an integral fixed abutment
in a single component
3 diameters -35 43 and 5 mm
4 lengths -10 13 15 and 16 mm
Clinical and radiographic evaluation of one-piece implants
used for immediate function
Jack a Hahn journal of oral implantology vol 33(3)2007
The aim of the present research was to evaluate the radiographic
outcome of a 1-piece implant when used for immediate function in
an ordinary patient pool
Forty-seven NobelDirect and NobelPerfect 1-piece implants
(Nobel Biocare Goumlteborg Sweden) were placed in maxillae and
mandibles
In this study 1 of the 47 implants had to be removed resulting in a
cumulative implant survival rate of 979 throughout the follow-up
period
The mean marginal bone level relative to the reference point after
1 year of loading (078 - 160 mm) as well as after 2 and 3 years of
loading was located above the first implant thread
In this study a bone level 2 mm apical to the reference point after
1 year of loading was observed at 2 implants (6)
The 1-piece implant design enables undisturbed healing
of the peri-implant soft tissue and avoids disruption of the
soft tissue seal when placing the definitive prosthetic
restoration
Annibali et al reported a series of patients treated
consecutively for first molar replacement according to
Immediate = group 1
Early = group 2
Late = Group 3
The implant survival rate
917 for early implants
950 for immediate post-extraction implants
100 for implants placed in healed sites
Short Dental Implants
A dental implant with length of 7 mm or less (Friberg et al 2000)
Any implant under 10 mm in length referred to as a lsquolsquoshortrsquorsquo
implant (Griffin TJ Cheung WS 2004)
A device with an intra-bony length of 8 mm or less (Renouard
and Nisand 2006)
Indication
Atropic Jaw
Proximity to vital structure
Single crowns
Overdentures
Advantages
1 Bone grafting for height often unnecessary
2 Less money pain and time prior to restoration of the implant
3 Simplified bone surgery
4 Implant insertion easier
Goodacre et al in 2003 reviewed
2754 implants - lt10 mm
3015 implants - gt10 mm in length
The failure rate of implants 10 mm or less was 10 compared
to a 3 failure rate of implants longer than 10 mm
Ivanoff et al in 1999 found an 8-mm-long 5-mm-diameter
implant failed 25 of the time in the maxilla and 33 of the
time in the mandible On the other hand the 10-mm and 12-
mm implants that were 5 mm in diameter reported no
mandibular failure and a 10 failure in the maxilla
Misch CE Short Dental Implants A Literature Review and Rationale for Use Dent Today 2005 Aug24(8)64-6 68
On the other hand a retrospective report by Misch et al was compiled
from 2 private offices using a square thread implant body design
(BioHorizons) rather than a v-shaped thread as primarily reported in the
previous literature
During a 3-year period 126 patients received implants less than 10 mm
long
Of the 437 implants there were 3 implant failures in the posterior
mandible and 1 failure in the posterior maxilla (99 survival)
All these failures were implants 9 mm long and 4 mm in diameter
Advances in Implant materials
Previously implants had macro-irregularities like macroscopic
threads fenestrations pores grooves steps threads or other
surface irregularities that were visible
However difficulty in achieving initial stability post implantation
relative motion adverse interfacial bone remodelling all lead to
search for improvement of the surface quality of a titanium dental
implant
BLASTING
Blasting -aluminium oxide titanium oxide and calcium phosphate
with particle size ranging from small medium to large (150- 350
microm)
Blasting a smooth Ti surface with Al2 O3 particles of 25 microm 75 microm
or 250 microm produces surfaces with roughness values of 116 to 120
143 and 194 to 220 respectively
A series of investigations have demonstrated a firmer bone
fixation of the implant with an average surface roughness (sa) of 1-
15microm than those of smoother implants with an average surface
roughness of 06microm
Blasting and Acid Etching
Acid etching can be done by using an HCL H2 SO4 mixture or by
pickling in 2 HF10HNO3 These processes leave pits and craters
Alumina or TiO2 for blasting the surface
Small - 25μm
large grit -025-05mm
medium grit - 250-500μm
Sand blasted and acid etched surfaces have a hydrophobic surface
The etching leads to the formation of Titanium hydrides and the
replacement of hydride by oxygen results in the slow transformation of
the implant surface resulting in nanometre sized particles of titanium on
the surface which helps in protein adhesion on implant surface
Dual acid etching with HCl and H2SO4 heated above 100ᴼC has
produced surface topography able to attach to fibrin scaffold and
promote adhesion of osteogenic cells
Sand blasting and etching can increase the rate and amount of the
bone formation
Flouride Surface Treatments
This treatment enhances osseointegration and osteoblastic
differentitation with increased expression of Cbfa1 osterix and
bone sialoprotein
Fluoridated rough implants also withstood greater push-out
forces and showed a significantly higher removal torque than
control implants
However detrimental effect of F on the corrosion resistance of
titanium and titanium alloys has been extensively reported
Anodized Surface Implants
Anodized surface implants are implants which are placed as anodes
in galvanic cells with phosphoric acid as the electrolyte and current is
passed through them ndash also ca ldquoTiunite surfacerdquo
The surface oxides grow from the native state of 5nm to
approximately 10000nm
The sa of TiUnite is reported to be 11microm and its sdr 37
Anodic oxidation results in the growth of a native titanium oxide
layer and a porous topography with the bone formation occurring
directly on the moderately rough oxidized surface
Clinical and Radiographic Evaluation of Braringnemark Implants with an
Anodized Surface following Seven-to-Eight Years of Functional Loading
David Gelb Bradley McaAllister et al Int J Dent 2013 2013 583567
The aim of this study was to evaluate the clinical and
radiographic long-term outcomes of dental implants with an
anodized TiUnite surface placed in routine clinical practice
38 single prosthesis
22 FPDs
80 implants in maxilla
27 in mandible
Mean marginal bone level change-149 plusmn 103 mm
907 of cases- no visible plaque93 -visible plaque
No prosthetic complication
Calandriello evaluated immediately placed anodized
implants in 33 patients and found a mean marginal bone
loss of 117thinspmm after 5 years
Friberg and Jemt compared 280 TiUnite implants to 110
machined implants in 111 patients and found marginal
bone loss after 5 years to be 075 and 06thinspmm respectively
with no significant difference between the two types of
implants
Laser etching and Micro Arc Oxidation
After the implants are ultrasonically cleaned they are laser etched
by using an NdYAG laser at a power of 50kw frequency of 75khz
and 164A current
They are then processed in an electrolyte solution with 35
glyceroposphate disodium salt pentahydrate and 12 calcium
acetate monohydrate by microarc oxidation (voltage 350v
frequency 800hz) for 15 seconds
Microarc oxidation produces a titania film with a porous structure
and micropores of 1-5microm
The mechanism of osseointegration of the oxidized implants has
been shown to be mechanical interlocking and biochemical
bonding
Surface coating Ti Plasma Spray
Porous rough Ti surface have been fabricated by plasma
spraying a Ti powder form of molten droplets at high temperature
at temperature in order of 15000C at 600ms
The Ti plasma spray after solidification often provides 004 ndash 005
mm thickness
Ti A spray has been reported to increase the surface area of bone
to implant interface (as much as 600) and stimulate adhesion
osteogenesis
Advantages
Enhance attachment by increasing ionic interactions
Increased load bearing capability by 25-30
Increased tensile strength through ingrowth of bony tissues into 3D feature
Disadvantages
Cracking and scaling of coating because of stresses produced by elevated temprature processing
Risk of accumulation of abraded material in the interface zone during implantation of TPS
Hydroxyapatite coatings
Hydroxyapatite [Ca10(PO4)6OH]2 coating was brought to the
dental profession by DeGroot
HA forms a strong chemical bond with bone due to the presence
of free calcium and phosphate compounds at the implant surface
The HA coating consists of amorphous and crystalline forms with
a large density of cracks
The top 1-2 microm of the HA layer being amorphous while the rest
of the crystalline layer is hexagonally packed
Indicated Fresh extraction sites
Newly grafted sites
Advantages
1 Protection of surrounding bone against metal ion release from the
substrate
2 Reported chemical bonding between HA and living bone-intimate
contact-biointegration
3 Partial dissolution of HA makes surrounding fluid rich in calcium
and phosphate ions which trigger cellular differentiation and bone
formation
Disadvantages
Induction of impurities due to thermal decomposition during
processing- affecting long term clinical fixation
Dissolution of HA at lower pH
HA coating on the implant surface (50-70microm) by various methods
1 Plasma spraying
2 The vacuum deposition technique(ion beam sputtering radiofrequency
sputtering)
3 The sol gel and dip coating method
4 Electrolytic process
Nanotitania coatings
Nanotitania coatings were prepared by using the sol-gel
technique
Nanotitania implants had an increased feature density and a large
feature coverage area as compared to the nano-HA implants
This could present more binding sites for the protein cell
attachment and for increased bone contact
he Nanotitania implants exhibited an ordered arrangement
forming a homogenous layer on underlying topography
Biologically active drugs incorporated dental
implants
Bisphosphonates Bisphosphate-loaded implant surfaces have
been reported to improve implant osseointegration
Simvastatin
Simvastatin could induce the expression of bone morphogenetic
protein (BMP) mRNA that might promote bone formation and
increase bone mineral density
Gentamycin along with the layer of HA can be coated onto the
implant surface which may act as a local prophylactic agent along
with the systemic antibiotics in dental implant surgery
Biochemical Methods
of the Surface
Modifications
Biochemical Methods of the Surface
Modifications
Their goal is to immobilize proteins enzymes or peptides on
biomaterials for the purpose of inducing specific cell and tissue
responses
1 One approach uses cell-adhesion molecules like fibronectin
vitronectin Type I collagen osteogenin and bone sialoprotein
2 The second approach uses biomolecules with osteotropic
effects which range from mitogenicity (interleukin growth
factor-I FGF-2 platelet derived growth factor ndashBB) to the
increasing activity of the bone cells which enhances the
collagen synthesis for osteoinduction
Zirconia implants
Zirconia (Zr02) is a ceramic material used in implantology because
Biocompatibility(bio inert)
Esthetics (because its colour is similar to the teeth) and
Mechanical properties which are better than alumina
High resistance to corrosion flexion and fracture
Contact with bone and soft tissue similar to that observed in
titanium implants
It can be used to produce a entire implant or as a coating
Advantages of Zirconia Dental Implants
No dark colour of the metal showing through the gums
No corrosion of the zirconia as with titanium
No piezo-electric currents between dissimilar metal in
the mouth
It is thermally non-conductive
Greater BIC (Bone ndash Implant Contact)
20 more bone apposition than titanium implants
Zeynep Ouml zkurt Zirconia Dental Implants A Literature Review Journal of Oral Implantology Vol 37(3)2011
RTQ (removal torque testing) Gahlert et al evaluated the RTQ values of
machined zirconia implants sandblasted zirconia implants and SLA titanium
implants The mean RTQ for machined zirconia implants was 259 Ncm the
mean RTQ for zirconia rough implants was 405 Ncm and the mean RTQ for
SLA titanium implants was 1052 Ncm
Fracture strength within clinically acceptable limits
Stress analysis Kohal et al observed the stress distribution patterns of
zirconia implants (ReImplant) which were found to have low well distributed
and similar stress distribution compared with titanium implants
PEEK implants (poly etheretherketone)
These implants are available in three fundamentally different
designs
TAU Diameter -48 mm lengths 10 125 15 mm
immediate loading possible
Low density bone
THETA Similar to TAU but D1 bone
IOTA It is a 3mm diameter implant (10 and 12 mm)
used in narrow ridges
Advantages
Good strengthfracture resistance and bioinertness
Promotes human oseteoblast cell growth
Disadvantages
Faintly radiopaque ndashdifficult for post-op evaluation
Lengths and diameters range is restricted
Advances in
commercially
available implant
systems
LASER- LOK TECHNOLOGY
Unique surface characteristics
Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using
laser ablation technology
Extremely consistent microchannels that are optimally
sized to attach and organize both osteoblasts and
fibroblasts
Includes a repeating nanostructure that maximizes
surface area and enables cell pseudopodia and collagen
microfibrils to interdigitate with the Laser-Lok surface
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Advances in
Diagnostic
Imaging
Imaging
Phase 1 Pre-prosthetic implant
imaging
Phase 2 Surgical and interventional implant imaging
Phase 3 Post-prosthetic implant
imaging
Determines the
bull Quantity quality and
angulation of bone
bullRelationship of critical
structures to prospective
implant sites
bull The presence or absence of
disease at the proposed
surgical sites
Evaluates the
surgical sites during
and immediately
after surgery
Evaluates the long-term
change
bull Crestal bone levels around
each implant
bull Changes in mineralization or
bone volume
ZONOGRAPHY
A modification of the panoramic x-ray machine for making
cross sectional images of the jaws
The tomographic layer is approximately 5mm
For appreciation of spatial relationship between the critical
structures and the implant siteLimitations
bullTomographic layers relatively thick
bullAdjacent structures blurring and superimposition
bullNot useful for determining the differences in
bone density or for identifying disease at implant
site
Tomography
Tomography is the generic name formed by the greek
words lsquotomorsquo(slice) and lsquographyrsquo(picture)
Enables visualization of a section of patientrsquos anatomy by
blurring other regions above and below the site of interest
For dental implant patients high quality complex motion
tomography is required
Computed tomography (CT)
CT was invented by Sir Godfrey Hounsfield and was introduced in
1972
Computed tomography (CT) is a digital and mathematical imaging
technique that creates tomographic sections and allows soft tissues
and hard tissues to be visualized simultaneously
Ideally tomographic sections spaced 1 to 2 mm enable evaluation of
implant site and 3D appearance of alveolus
With latest CT scanners images with sectional thickness of 025 mm
can be obtained
The advantages of CT based systems are
Uniform magnification
High contrast image with well-defined image layer free of
blurring
Easier identification of bone grafts or hydroxyappatite materials
used to augment maxillary bone in sinus region
Multiplanar views
Three-dimensional reconstruction
Simultaneous study of multiple implant sites
Availability of soft tissue for image analysis
Disadvantages
Limited availability of reconstructive software
Higher dose of radiation
Lack of understanding of dentists
Lack of usefulness for implant interface follow-up because of
metallic streak artifacts
Expense
Recent advances in Computed Tomography(CT)
Tuned Aperture CT (TACT)
Tuned aperture computed tomography (TACT) by Webber is a
relatively simple faster method for reconstructing tomographic
images
It is based on the concept of tomo-synthesis and optical-aperture
theory
TACT uses 2-D periapical radiographs acquired from different
projection angles as base images and permits retrospective
generation of longitudinal tomographic slices (TACT-S) lining up in
the Z axis of the area of interest
The overall radiation dose of TACT is not greater than 1 to 2 times
that of a conventional periapical X-ray film
The resolution is stated to be similar with 2-D radiographs
Artefacts associated with CT such as starburst patterns seen with
metallic restorations do not exist with TACT
The big conceptCone Bean Computed Tomography
Cone Beam Computed Tomography
Fan beam Cone beam
Software programs incorporating sophisticated
algorithms including back-filtered projection are applied
to these image data to generate a 3D volumetric data set
which can be used to provide primary reconstruction
images in 3 orthogonal planes (axial sagittal and coronal)
CBCT is devoted to maxillofacial area to scan and
visualize jaw bone lesions especially cancellous bone
It gives all the information of a CT but at 18th the
radiation dose and at a lower cost
CBCT is categorized into large medium and limited volume units based on the size
of their field of view (FOV)
Large (FOV)
bull 15-23 cm
bull Maxillofacial trauma
bull Orthodontic use
bull TMJ diseases
Medium FOV
bull 10-15 cm
bull Mandibulo-maxillary imaging
bull Pre-implant planning
bull Pathology
Small FOV
bull lt 10 cm
bull Endodontic applications
Advantages of CBCT
X-ray beam limitation
Image accuracy
Rapid scan time 10ndash70 seconds
Software can be made available to the user
Dose reduction Effective dose is 98 smaller than conventional CT
Reduced image artifact
Interactive computed tomography(ICT)
bullThis technique enables transfer of the imaging study to the
clinician as a computer filehellip
bullThe clinicianrsquos computer becomes a diagnostic radiologic
workstation with tools
bullAn important feature of ICT is that the clinician and radiologist can
perform ldquoelectronic surgeryrdquo (ES)
bull With an appropriately designed diagnostic
template ES can be performed to develop
the patientrsquos treatment plan electronically in
3 dimensions
bullTransfer of the plan to the patient at the
time of surgery can be accomplished by
production of the computer generated
three-dimensional stereotactic surgical
templates
Recent advances in
Computed Tomography(CT)
Microtomograph
Modification of CT it is specially useful in acquiring serial sections of bone
implant interface
Multi slice helical CT
The helical CT scan takes continuous pictures of the body in a rapid spiral motion
so that there are no gaps in the pictures collected
Recent Advances
in Implant Design
Mini implants
Mini dental implants (MDIs) are small diameter dental implants
Are sometimes referred to as SDIs (small diameter implants) as
well as NDIs (narrow body implants)
Diameter 18mm to 29mm (less than 3mm)
Various lengths 10 13 15 amp 18 mmrsquos
The MDI are available with either an O-ball head for use with
removable or fixed dentures or a square head for fixed prostheses or
retrofitting a poorly adapted partial denture
The body connects the tip with the prosthetic head and can be a
parallel sided cylinder or a progressively tapered cone
A small pilot bit is used to create the opening for the implant to be
threaded into the bone
The definitive implant supported crowns are usually delivered
within 2 weeks of surgery
Advantages
Immediate loading
Can be inserted in minimal tissues without relying on grafting
techniques
Minimally invasive procedure
One-stage denture stabilization
Does not require osteotomy
Cost-effective
Can be placed with a simple technique in patients with ridge too
narrow for conventional implants
Narrow-diameter implants Are they a predictable
treatment option A literature review
Joseacute-Luis Sierra-Saacutenchez Med Oral Patol Oral Cir Bucal 2014
Jan 119 (1)e74-81
The review included
Four randomized clinical trials
Ten prospective studies
Seven retrospective studies
The follow-up periods -12 months to 12 years
Total of 1607 patients
The patient age - 13 to 87 years
2980 implants
The recorded implant survival rates were above 90 in all the
studies Six studies published a survival rate of 100 at the end of
the follow-up period
The lowest survival rate (909) corresponded to the study
published by Barter et al
58 failures (implant loss) were recorded out of a total of 2980
implants
A larger number of failures were recorded with implants measuring
le 13 mm in length
Nineteen studies measured changes in peri-implant bone height
after implant loading 0065 mm the first year to 174 mm after a
follow-up period of 10 years
Araujo published a retrospective study on 33 mm implants placed
in posterior areas and rehabilitated following an immediate loading
protocol
Implant survival rate was 955 after 9 years of follow-up
That same year Degidi et al published a study comparing delayed
and immediate loading in narrow-diameter implants placed in both
anterior and posterior zones
Survival rate was 994 after a mean follow-up of 20 months
TRANSITIONAL IMPLANTS
Diameter ranges -18 to 28 mm
Length -7mm to 14mm
Fabricated with pure titanium in a single body with treated
surface
Primary function is to absorb masticatory stress during healing
phase
They should be placed at least 15 mm from adjacent teeth and
the distance between any transitional implant and a definitive
implant must be at least 15-2 mm
The abutment head generally has a 5 degree taper which makes it
optimal for retention of cement retained prostheses
Only one drill a 15 mm or 2 mm twist drill is required for
placement of the implants
Advantages
Provisionalisation of fully and partially edentulous jaws
Undisturbed healing of bone grafts
Effective way to generate aesthetic transitional appliances
Allows evaluation of phonetics and function
Cost effective
One ndash Piece Implants
The implant is machined from a piece of titanium that
incorporates both the implant body and an integral fixed abutment
in a single component
3 diameters -35 43 and 5 mm
4 lengths -10 13 15 and 16 mm
Clinical and radiographic evaluation of one-piece implants
used for immediate function
Jack a Hahn journal of oral implantology vol 33(3)2007
The aim of the present research was to evaluate the radiographic
outcome of a 1-piece implant when used for immediate function in
an ordinary patient pool
Forty-seven NobelDirect and NobelPerfect 1-piece implants
(Nobel Biocare Goumlteborg Sweden) were placed in maxillae and
mandibles
In this study 1 of the 47 implants had to be removed resulting in a
cumulative implant survival rate of 979 throughout the follow-up
period
The mean marginal bone level relative to the reference point after
1 year of loading (078 - 160 mm) as well as after 2 and 3 years of
loading was located above the first implant thread
In this study a bone level 2 mm apical to the reference point after
1 year of loading was observed at 2 implants (6)
The 1-piece implant design enables undisturbed healing
of the peri-implant soft tissue and avoids disruption of the
soft tissue seal when placing the definitive prosthetic
restoration
Annibali et al reported a series of patients treated
consecutively for first molar replacement according to
Immediate = group 1
Early = group 2
Late = Group 3
The implant survival rate
917 for early implants
950 for immediate post-extraction implants
100 for implants placed in healed sites
Short Dental Implants
A dental implant with length of 7 mm or less (Friberg et al 2000)
Any implant under 10 mm in length referred to as a lsquolsquoshortrsquorsquo
implant (Griffin TJ Cheung WS 2004)
A device with an intra-bony length of 8 mm or less (Renouard
and Nisand 2006)
Indication
Atropic Jaw
Proximity to vital structure
Single crowns
Overdentures
Advantages
1 Bone grafting for height often unnecessary
2 Less money pain and time prior to restoration of the implant
3 Simplified bone surgery
4 Implant insertion easier
Goodacre et al in 2003 reviewed
2754 implants - lt10 mm
3015 implants - gt10 mm in length
The failure rate of implants 10 mm or less was 10 compared
to a 3 failure rate of implants longer than 10 mm
Ivanoff et al in 1999 found an 8-mm-long 5-mm-diameter
implant failed 25 of the time in the maxilla and 33 of the
time in the mandible On the other hand the 10-mm and 12-
mm implants that were 5 mm in diameter reported no
mandibular failure and a 10 failure in the maxilla
Misch CE Short Dental Implants A Literature Review and Rationale for Use Dent Today 2005 Aug24(8)64-6 68
On the other hand a retrospective report by Misch et al was compiled
from 2 private offices using a square thread implant body design
(BioHorizons) rather than a v-shaped thread as primarily reported in the
previous literature
During a 3-year period 126 patients received implants less than 10 mm
long
Of the 437 implants there were 3 implant failures in the posterior
mandible and 1 failure in the posterior maxilla (99 survival)
All these failures were implants 9 mm long and 4 mm in diameter
Advances in Implant materials
Previously implants had macro-irregularities like macroscopic
threads fenestrations pores grooves steps threads or other
surface irregularities that were visible
However difficulty in achieving initial stability post implantation
relative motion adverse interfacial bone remodelling all lead to
search for improvement of the surface quality of a titanium dental
implant
BLASTING
Blasting -aluminium oxide titanium oxide and calcium phosphate
with particle size ranging from small medium to large (150- 350
microm)
Blasting a smooth Ti surface with Al2 O3 particles of 25 microm 75 microm
or 250 microm produces surfaces with roughness values of 116 to 120
143 and 194 to 220 respectively
A series of investigations have demonstrated a firmer bone
fixation of the implant with an average surface roughness (sa) of 1-
15microm than those of smoother implants with an average surface
roughness of 06microm
Blasting and Acid Etching
Acid etching can be done by using an HCL H2 SO4 mixture or by
pickling in 2 HF10HNO3 These processes leave pits and craters
Alumina or TiO2 for blasting the surface
Small - 25μm
large grit -025-05mm
medium grit - 250-500μm
Sand blasted and acid etched surfaces have a hydrophobic surface
The etching leads to the formation of Titanium hydrides and the
replacement of hydride by oxygen results in the slow transformation of
the implant surface resulting in nanometre sized particles of titanium on
the surface which helps in protein adhesion on implant surface
Dual acid etching with HCl and H2SO4 heated above 100ᴼC has
produced surface topography able to attach to fibrin scaffold and
promote adhesion of osteogenic cells
Sand blasting and etching can increase the rate and amount of the
bone formation
Flouride Surface Treatments
This treatment enhances osseointegration and osteoblastic
differentitation with increased expression of Cbfa1 osterix and
bone sialoprotein
Fluoridated rough implants also withstood greater push-out
forces and showed a significantly higher removal torque than
control implants
However detrimental effect of F on the corrosion resistance of
titanium and titanium alloys has been extensively reported
Anodized Surface Implants
Anodized surface implants are implants which are placed as anodes
in galvanic cells with phosphoric acid as the electrolyte and current is
passed through them ndash also ca ldquoTiunite surfacerdquo
The surface oxides grow from the native state of 5nm to
approximately 10000nm
The sa of TiUnite is reported to be 11microm and its sdr 37
Anodic oxidation results in the growth of a native titanium oxide
layer and a porous topography with the bone formation occurring
directly on the moderately rough oxidized surface
Clinical and Radiographic Evaluation of Braringnemark Implants with an
Anodized Surface following Seven-to-Eight Years of Functional Loading
David Gelb Bradley McaAllister et al Int J Dent 2013 2013 583567
The aim of this study was to evaluate the clinical and
radiographic long-term outcomes of dental implants with an
anodized TiUnite surface placed in routine clinical practice
38 single prosthesis
22 FPDs
80 implants in maxilla
27 in mandible
Mean marginal bone level change-149 plusmn 103 mm
907 of cases- no visible plaque93 -visible plaque
No prosthetic complication
Calandriello evaluated immediately placed anodized
implants in 33 patients and found a mean marginal bone
loss of 117thinspmm after 5 years
Friberg and Jemt compared 280 TiUnite implants to 110
machined implants in 111 patients and found marginal
bone loss after 5 years to be 075 and 06thinspmm respectively
with no significant difference between the two types of
implants
Laser etching and Micro Arc Oxidation
After the implants are ultrasonically cleaned they are laser etched
by using an NdYAG laser at a power of 50kw frequency of 75khz
and 164A current
They are then processed in an electrolyte solution with 35
glyceroposphate disodium salt pentahydrate and 12 calcium
acetate monohydrate by microarc oxidation (voltage 350v
frequency 800hz) for 15 seconds
Microarc oxidation produces a titania film with a porous structure
and micropores of 1-5microm
The mechanism of osseointegration of the oxidized implants has
been shown to be mechanical interlocking and biochemical
bonding
Surface coating Ti Plasma Spray
Porous rough Ti surface have been fabricated by plasma
spraying a Ti powder form of molten droplets at high temperature
at temperature in order of 15000C at 600ms
The Ti plasma spray after solidification often provides 004 ndash 005
mm thickness
Ti A spray has been reported to increase the surface area of bone
to implant interface (as much as 600) and stimulate adhesion
osteogenesis
Advantages
Enhance attachment by increasing ionic interactions
Increased load bearing capability by 25-30
Increased tensile strength through ingrowth of bony tissues into 3D feature
Disadvantages
Cracking and scaling of coating because of stresses produced by elevated temprature processing
Risk of accumulation of abraded material in the interface zone during implantation of TPS
Hydroxyapatite coatings
Hydroxyapatite [Ca10(PO4)6OH]2 coating was brought to the
dental profession by DeGroot
HA forms a strong chemical bond with bone due to the presence
of free calcium and phosphate compounds at the implant surface
The HA coating consists of amorphous and crystalline forms with
a large density of cracks
The top 1-2 microm of the HA layer being amorphous while the rest
of the crystalline layer is hexagonally packed
Indicated Fresh extraction sites
Newly grafted sites
Advantages
1 Protection of surrounding bone against metal ion release from the
substrate
2 Reported chemical bonding between HA and living bone-intimate
contact-biointegration
3 Partial dissolution of HA makes surrounding fluid rich in calcium
and phosphate ions which trigger cellular differentiation and bone
formation
Disadvantages
Induction of impurities due to thermal decomposition during
processing- affecting long term clinical fixation
Dissolution of HA at lower pH
HA coating on the implant surface (50-70microm) by various methods
1 Plasma spraying
2 The vacuum deposition technique(ion beam sputtering radiofrequency
sputtering)
3 The sol gel and dip coating method
4 Electrolytic process
Nanotitania coatings
Nanotitania coatings were prepared by using the sol-gel
technique
Nanotitania implants had an increased feature density and a large
feature coverage area as compared to the nano-HA implants
This could present more binding sites for the protein cell
attachment and for increased bone contact
he Nanotitania implants exhibited an ordered arrangement
forming a homogenous layer on underlying topography
Biologically active drugs incorporated dental
implants
Bisphosphonates Bisphosphate-loaded implant surfaces have
been reported to improve implant osseointegration
Simvastatin
Simvastatin could induce the expression of bone morphogenetic
protein (BMP) mRNA that might promote bone formation and
increase bone mineral density
Gentamycin along with the layer of HA can be coated onto the
implant surface which may act as a local prophylactic agent along
with the systemic antibiotics in dental implant surgery
Biochemical Methods
of the Surface
Modifications
Biochemical Methods of the Surface
Modifications
Their goal is to immobilize proteins enzymes or peptides on
biomaterials for the purpose of inducing specific cell and tissue
responses
1 One approach uses cell-adhesion molecules like fibronectin
vitronectin Type I collagen osteogenin and bone sialoprotein
2 The second approach uses biomolecules with osteotropic
effects which range from mitogenicity (interleukin growth
factor-I FGF-2 platelet derived growth factor ndashBB) to the
increasing activity of the bone cells which enhances the
collagen synthesis for osteoinduction
Zirconia implants
Zirconia (Zr02) is a ceramic material used in implantology because
Biocompatibility(bio inert)
Esthetics (because its colour is similar to the teeth) and
Mechanical properties which are better than alumina
High resistance to corrosion flexion and fracture
Contact with bone and soft tissue similar to that observed in
titanium implants
It can be used to produce a entire implant or as a coating
Advantages of Zirconia Dental Implants
No dark colour of the metal showing through the gums
No corrosion of the zirconia as with titanium
No piezo-electric currents between dissimilar metal in
the mouth
It is thermally non-conductive
Greater BIC (Bone ndash Implant Contact)
20 more bone apposition than titanium implants
Zeynep Ouml zkurt Zirconia Dental Implants A Literature Review Journal of Oral Implantology Vol 37(3)2011
RTQ (removal torque testing) Gahlert et al evaluated the RTQ values of
machined zirconia implants sandblasted zirconia implants and SLA titanium
implants The mean RTQ for machined zirconia implants was 259 Ncm the
mean RTQ for zirconia rough implants was 405 Ncm and the mean RTQ for
SLA titanium implants was 1052 Ncm
Fracture strength within clinically acceptable limits
Stress analysis Kohal et al observed the stress distribution patterns of
zirconia implants (ReImplant) which were found to have low well distributed
and similar stress distribution compared with titanium implants
PEEK implants (poly etheretherketone)
These implants are available in three fundamentally different
designs
TAU Diameter -48 mm lengths 10 125 15 mm
immediate loading possible
Low density bone
THETA Similar to TAU but D1 bone
IOTA It is a 3mm diameter implant (10 and 12 mm)
used in narrow ridges
Advantages
Good strengthfracture resistance and bioinertness
Promotes human oseteoblast cell growth
Disadvantages
Faintly radiopaque ndashdifficult for post-op evaluation
Lengths and diameters range is restricted
Advances in
commercially
available implant
systems
LASER- LOK TECHNOLOGY
Unique surface characteristics
Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using
laser ablation technology
Extremely consistent microchannels that are optimally
sized to attach and organize both osteoblasts and
fibroblasts
Includes a repeating nanostructure that maximizes
surface area and enables cell pseudopodia and collagen
microfibrils to interdigitate with the Laser-Lok surface
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Imaging
Phase 1 Pre-prosthetic implant
imaging
Phase 2 Surgical and interventional implant imaging
Phase 3 Post-prosthetic implant
imaging
Determines the
bull Quantity quality and
angulation of bone
bullRelationship of critical
structures to prospective
implant sites
bull The presence or absence of
disease at the proposed
surgical sites
Evaluates the
surgical sites during
and immediately
after surgery
Evaluates the long-term
change
bull Crestal bone levels around
each implant
bull Changes in mineralization or
bone volume
ZONOGRAPHY
A modification of the panoramic x-ray machine for making
cross sectional images of the jaws
The tomographic layer is approximately 5mm
For appreciation of spatial relationship between the critical
structures and the implant siteLimitations
bullTomographic layers relatively thick
bullAdjacent structures blurring and superimposition
bullNot useful for determining the differences in
bone density or for identifying disease at implant
site
Tomography
Tomography is the generic name formed by the greek
words lsquotomorsquo(slice) and lsquographyrsquo(picture)
Enables visualization of a section of patientrsquos anatomy by
blurring other regions above and below the site of interest
For dental implant patients high quality complex motion
tomography is required
Computed tomography (CT)
CT was invented by Sir Godfrey Hounsfield and was introduced in
1972
Computed tomography (CT) is a digital and mathematical imaging
technique that creates tomographic sections and allows soft tissues
and hard tissues to be visualized simultaneously
Ideally tomographic sections spaced 1 to 2 mm enable evaluation of
implant site and 3D appearance of alveolus
With latest CT scanners images with sectional thickness of 025 mm
can be obtained
The advantages of CT based systems are
Uniform magnification
High contrast image with well-defined image layer free of
blurring
Easier identification of bone grafts or hydroxyappatite materials
used to augment maxillary bone in sinus region
Multiplanar views
Three-dimensional reconstruction
Simultaneous study of multiple implant sites
Availability of soft tissue for image analysis
Disadvantages
Limited availability of reconstructive software
Higher dose of radiation
Lack of understanding of dentists
Lack of usefulness for implant interface follow-up because of
metallic streak artifacts
Expense
Recent advances in Computed Tomography(CT)
Tuned Aperture CT (TACT)
Tuned aperture computed tomography (TACT) by Webber is a
relatively simple faster method for reconstructing tomographic
images
It is based on the concept of tomo-synthesis and optical-aperture
theory
TACT uses 2-D periapical radiographs acquired from different
projection angles as base images and permits retrospective
generation of longitudinal tomographic slices (TACT-S) lining up in
the Z axis of the area of interest
The overall radiation dose of TACT is not greater than 1 to 2 times
that of a conventional periapical X-ray film
The resolution is stated to be similar with 2-D radiographs
Artefacts associated with CT such as starburst patterns seen with
metallic restorations do not exist with TACT
The big conceptCone Bean Computed Tomography
Cone Beam Computed Tomography
Fan beam Cone beam
Software programs incorporating sophisticated
algorithms including back-filtered projection are applied
to these image data to generate a 3D volumetric data set
which can be used to provide primary reconstruction
images in 3 orthogonal planes (axial sagittal and coronal)
CBCT is devoted to maxillofacial area to scan and
visualize jaw bone lesions especially cancellous bone
It gives all the information of a CT but at 18th the
radiation dose and at a lower cost
CBCT is categorized into large medium and limited volume units based on the size
of their field of view (FOV)
Large (FOV)
bull 15-23 cm
bull Maxillofacial trauma
bull Orthodontic use
bull TMJ diseases
Medium FOV
bull 10-15 cm
bull Mandibulo-maxillary imaging
bull Pre-implant planning
bull Pathology
Small FOV
bull lt 10 cm
bull Endodontic applications
Advantages of CBCT
X-ray beam limitation
Image accuracy
Rapid scan time 10ndash70 seconds
Software can be made available to the user
Dose reduction Effective dose is 98 smaller than conventional CT
Reduced image artifact
Interactive computed tomography(ICT)
bullThis technique enables transfer of the imaging study to the
clinician as a computer filehellip
bullThe clinicianrsquos computer becomes a diagnostic radiologic
workstation with tools
bullAn important feature of ICT is that the clinician and radiologist can
perform ldquoelectronic surgeryrdquo (ES)
bull With an appropriately designed diagnostic
template ES can be performed to develop
the patientrsquos treatment plan electronically in
3 dimensions
bullTransfer of the plan to the patient at the
time of surgery can be accomplished by
production of the computer generated
three-dimensional stereotactic surgical
templates
Recent advances in
Computed Tomography(CT)
Microtomograph
Modification of CT it is specially useful in acquiring serial sections of bone
implant interface
Multi slice helical CT
The helical CT scan takes continuous pictures of the body in a rapid spiral motion
so that there are no gaps in the pictures collected
Recent Advances
in Implant Design
Mini implants
Mini dental implants (MDIs) are small diameter dental implants
Are sometimes referred to as SDIs (small diameter implants) as
well as NDIs (narrow body implants)
Diameter 18mm to 29mm (less than 3mm)
Various lengths 10 13 15 amp 18 mmrsquos
The MDI are available with either an O-ball head for use with
removable or fixed dentures or a square head for fixed prostheses or
retrofitting a poorly adapted partial denture
The body connects the tip with the prosthetic head and can be a
parallel sided cylinder or a progressively tapered cone
A small pilot bit is used to create the opening for the implant to be
threaded into the bone
The definitive implant supported crowns are usually delivered
within 2 weeks of surgery
Advantages
Immediate loading
Can be inserted in minimal tissues without relying on grafting
techniques
Minimally invasive procedure
One-stage denture stabilization
Does not require osteotomy
Cost-effective
Can be placed with a simple technique in patients with ridge too
narrow for conventional implants
Narrow-diameter implants Are they a predictable
treatment option A literature review
Joseacute-Luis Sierra-Saacutenchez Med Oral Patol Oral Cir Bucal 2014
Jan 119 (1)e74-81
The review included
Four randomized clinical trials
Ten prospective studies
Seven retrospective studies
The follow-up periods -12 months to 12 years
Total of 1607 patients
The patient age - 13 to 87 years
2980 implants
The recorded implant survival rates were above 90 in all the
studies Six studies published a survival rate of 100 at the end of
the follow-up period
The lowest survival rate (909) corresponded to the study
published by Barter et al
58 failures (implant loss) were recorded out of a total of 2980
implants
A larger number of failures were recorded with implants measuring
le 13 mm in length
Nineteen studies measured changes in peri-implant bone height
after implant loading 0065 mm the first year to 174 mm after a
follow-up period of 10 years
Araujo published a retrospective study on 33 mm implants placed
in posterior areas and rehabilitated following an immediate loading
protocol
Implant survival rate was 955 after 9 years of follow-up
That same year Degidi et al published a study comparing delayed
and immediate loading in narrow-diameter implants placed in both
anterior and posterior zones
Survival rate was 994 after a mean follow-up of 20 months
TRANSITIONAL IMPLANTS
Diameter ranges -18 to 28 mm
Length -7mm to 14mm
Fabricated with pure titanium in a single body with treated
surface
Primary function is to absorb masticatory stress during healing
phase
They should be placed at least 15 mm from adjacent teeth and
the distance between any transitional implant and a definitive
implant must be at least 15-2 mm
The abutment head generally has a 5 degree taper which makes it
optimal for retention of cement retained prostheses
Only one drill a 15 mm or 2 mm twist drill is required for
placement of the implants
Advantages
Provisionalisation of fully and partially edentulous jaws
Undisturbed healing of bone grafts
Effective way to generate aesthetic transitional appliances
Allows evaluation of phonetics and function
Cost effective
One ndash Piece Implants
The implant is machined from a piece of titanium that
incorporates both the implant body and an integral fixed abutment
in a single component
3 diameters -35 43 and 5 mm
4 lengths -10 13 15 and 16 mm
Clinical and radiographic evaluation of one-piece implants
used for immediate function
Jack a Hahn journal of oral implantology vol 33(3)2007
The aim of the present research was to evaluate the radiographic
outcome of a 1-piece implant when used for immediate function in
an ordinary patient pool
Forty-seven NobelDirect and NobelPerfect 1-piece implants
(Nobel Biocare Goumlteborg Sweden) were placed in maxillae and
mandibles
In this study 1 of the 47 implants had to be removed resulting in a
cumulative implant survival rate of 979 throughout the follow-up
period
The mean marginal bone level relative to the reference point after
1 year of loading (078 - 160 mm) as well as after 2 and 3 years of
loading was located above the first implant thread
In this study a bone level 2 mm apical to the reference point after
1 year of loading was observed at 2 implants (6)
The 1-piece implant design enables undisturbed healing
of the peri-implant soft tissue and avoids disruption of the
soft tissue seal when placing the definitive prosthetic
restoration
Annibali et al reported a series of patients treated
consecutively for first molar replacement according to
Immediate = group 1
Early = group 2
Late = Group 3
The implant survival rate
917 for early implants
950 for immediate post-extraction implants
100 for implants placed in healed sites
Short Dental Implants
A dental implant with length of 7 mm or less (Friberg et al 2000)
Any implant under 10 mm in length referred to as a lsquolsquoshortrsquorsquo
implant (Griffin TJ Cheung WS 2004)
A device with an intra-bony length of 8 mm or less (Renouard
and Nisand 2006)
Indication
Atropic Jaw
Proximity to vital structure
Single crowns
Overdentures
Advantages
1 Bone grafting for height often unnecessary
2 Less money pain and time prior to restoration of the implant
3 Simplified bone surgery
4 Implant insertion easier
Goodacre et al in 2003 reviewed
2754 implants - lt10 mm
3015 implants - gt10 mm in length
The failure rate of implants 10 mm or less was 10 compared
to a 3 failure rate of implants longer than 10 mm
Ivanoff et al in 1999 found an 8-mm-long 5-mm-diameter
implant failed 25 of the time in the maxilla and 33 of the
time in the mandible On the other hand the 10-mm and 12-
mm implants that were 5 mm in diameter reported no
mandibular failure and a 10 failure in the maxilla
Misch CE Short Dental Implants A Literature Review and Rationale for Use Dent Today 2005 Aug24(8)64-6 68
On the other hand a retrospective report by Misch et al was compiled
from 2 private offices using a square thread implant body design
(BioHorizons) rather than a v-shaped thread as primarily reported in the
previous literature
During a 3-year period 126 patients received implants less than 10 mm
long
Of the 437 implants there were 3 implant failures in the posterior
mandible and 1 failure in the posterior maxilla (99 survival)
All these failures were implants 9 mm long and 4 mm in diameter
Advances in Implant materials
Previously implants had macro-irregularities like macroscopic
threads fenestrations pores grooves steps threads or other
surface irregularities that were visible
However difficulty in achieving initial stability post implantation
relative motion adverse interfacial bone remodelling all lead to
search for improvement of the surface quality of a titanium dental
implant
BLASTING
Blasting -aluminium oxide titanium oxide and calcium phosphate
with particle size ranging from small medium to large (150- 350
microm)
Blasting a smooth Ti surface with Al2 O3 particles of 25 microm 75 microm
or 250 microm produces surfaces with roughness values of 116 to 120
143 and 194 to 220 respectively
A series of investigations have demonstrated a firmer bone
fixation of the implant with an average surface roughness (sa) of 1-
15microm than those of smoother implants with an average surface
roughness of 06microm
Blasting and Acid Etching
Acid etching can be done by using an HCL H2 SO4 mixture or by
pickling in 2 HF10HNO3 These processes leave pits and craters
Alumina or TiO2 for blasting the surface
Small - 25μm
large grit -025-05mm
medium grit - 250-500μm
Sand blasted and acid etched surfaces have a hydrophobic surface
The etching leads to the formation of Titanium hydrides and the
replacement of hydride by oxygen results in the slow transformation of
the implant surface resulting in nanometre sized particles of titanium on
the surface which helps in protein adhesion on implant surface
Dual acid etching with HCl and H2SO4 heated above 100ᴼC has
produced surface topography able to attach to fibrin scaffold and
promote adhesion of osteogenic cells
Sand blasting and etching can increase the rate and amount of the
bone formation
Flouride Surface Treatments
This treatment enhances osseointegration and osteoblastic
differentitation with increased expression of Cbfa1 osterix and
bone sialoprotein
Fluoridated rough implants also withstood greater push-out
forces and showed a significantly higher removal torque than
control implants
However detrimental effect of F on the corrosion resistance of
titanium and titanium alloys has been extensively reported
Anodized Surface Implants
Anodized surface implants are implants which are placed as anodes
in galvanic cells with phosphoric acid as the electrolyte and current is
passed through them ndash also ca ldquoTiunite surfacerdquo
The surface oxides grow from the native state of 5nm to
approximately 10000nm
The sa of TiUnite is reported to be 11microm and its sdr 37
Anodic oxidation results in the growth of a native titanium oxide
layer and a porous topography with the bone formation occurring
directly on the moderately rough oxidized surface
Clinical and Radiographic Evaluation of Braringnemark Implants with an
Anodized Surface following Seven-to-Eight Years of Functional Loading
David Gelb Bradley McaAllister et al Int J Dent 2013 2013 583567
The aim of this study was to evaluate the clinical and
radiographic long-term outcomes of dental implants with an
anodized TiUnite surface placed in routine clinical practice
38 single prosthesis
22 FPDs
80 implants in maxilla
27 in mandible
Mean marginal bone level change-149 plusmn 103 mm
907 of cases- no visible plaque93 -visible plaque
No prosthetic complication
Calandriello evaluated immediately placed anodized
implants in 33 patients and found a mean marginal bone
loss of 117thinspmm after 5 years
Friberg and Jemt compared 280 TiUnite implants to 110
machined implants in 111 patients and found marginal
bone loss after 5 years to be 075 and 06thinspmm respectively
with no significant difference between the two types of
implants
Laser etching and Micro Arc Oxidation
After the implants are ultrasonically cleaned they are laser etched
by using an NdYAG laser at a power of 50kw frequency of 75khz
and 164A current
They are then processed in an electrolyte solution with 35
glyceroposphate disodium salt pentahydrate and 12 calcium
acetate monohydrate by microarc oxidation (voltage 350v
frequency 800hz) for 15 seconds
Microarc oxidation produces a titania film with a porous structure
and micropores of 1-5microm
The mechanism of osseointegration of the oxidized implants has
been shown to be mechanical interlocking and biochemical
bonding
Surface coating Ti Plasma Spray
Porous rough Ti surface have been fabricated by plasma
spraying a Ti powder form of molten droplets at high temperature
at temperature in order of 15000C at 600ms
The Ti plasma spray after solidification often provides 004 ndash 005
mm thickness
Ti A spray has been reported to increase the surface area of bone
to implant interface (as much as 600) and stimulate adhesion
osteogenesis
Advantages
Enhance attachment by increasing ionic interactions
Increased load bearing capability by 25-30
Increased tensile strength through ingrowth of bony tissues into 3D feature
Disadvantages
Cracking and scaling of coating because of stresses produced by elevated temprature processing
Risk of accumulation of abraded material in the interface zone during implantation of TPS
Hydroxyapatite coatings
Hydroxyapatite [Ca10(PO4)6OH]2 coating was brought to the
dental profession by DeGroot
HA forms a strong chemical bond with bone due to the presence
of free calcium and phosphate compounds at the implant surface
The HA coating consists of amorphous and crystalline forms with
a large density of cracks
The top 1-2 microm of the HA layer being amorphous while the rest
of the crystalline layer is hexagonally packed
Indicated Fresh extraction sites
Newly grafted sites
Advantages
1 Protection of surrounding bone against metal ion release from the
substrate
2 Reported chemical bonding between HA and living bone-intimate
contact-biointegration
3 Partial dissolution of HA makes surrounding fluid rich in calcium
and phosphate ions which trigger cellular differentiation and bone
formation
Disadvantages
Induction of impurities due to thermal decomposition during
processing- affecting long term clinical fixation
Dissolution of HA at lower pH
HA coating on the implant surface (50-70microm) by various methods
1 Plasma spraying
2 The vacuum deposition technique(ion beam sputtering radiofrequency
sputtering)
3 The sol gel and dip coating method
4 Electrolytic process
Nanotitania coatings
Nanotitania coatings were prepared by using the sol-gel
technique
Nanotitania implants had an increased feature density and a large
feature coverage area as compared to the nano-HA implants
This could present more binding sites for the protein cell
attachment and for increased bone contact
he Nanotitania implants exhibited an ordered arrangement
forming a homogenous layer on underlying topography
Biologically active drugs incorporated dental
implants
Bisphosphonates Bisphosphate-loaded implant surfaces have
been reported to improve implant osseointegration
Simvastatin
Simvastatin could induce the expression of bone morphogenetic
protein (BMP) mRNA that might promote bone formation and
increase bone mineral density
Gentamycin along with the layer of HA can be coated onto the
implant surface which may act as a local prophylactic agent along
with the systemic antibiotics in dental implant surgery
Biochemical Methods
of the Surface
Modifications
Biochemical Methods of the Surface
Modifications
Their goal is to immobilize proteins enzymes or peptides on
biomaterials for the purpose of inducing specific cell and tissue
responses
1 One approach uses cell-adhesion molecules like fibronectin
vitronectin Type I collagen osteogenin and bone sialoprotein
2 The second approach uses biomolecules with osteotropic
effects which range from mitogenicity (interleukin growth
factor-I FGF-2 platelet derived growth factor ndashBB) to the
increasing activity of the bone cells which enhances the
collagen synthesis for osteoinduction
Zirconia implants
Zirconia (Zr02) is a ceramic material used in implantology because
Biocompatibility(bio inert)
Esthetics (because its colour is similar to the teeth) and
Mechanical properties which are better than alumina
High resistance to corrosion flexion and fracture
Contact with bone and soft tissue similar to that observed in
titanium implants
It can be used to produce a entire implant or as a coating
Advantages of Zirconia Dental Implants
No dark colour of the metal showing through the gums
No corrosion of the zirconia as with titanium
No piezo-electric currents between dissimilar metal in
the mouth
It is thermally non-conductive
Greater BIC (Bone ndash Implant Contact)
20 more bone apposition than titanium implants
Zeynep Ouml zkurt Zirconia Dental Implants A Literature Review Journal of Oral Implantology Vol 37(3)2011
RTQ (removal torque testing) Gahlert et al evaluated the RTQ values of
machined zirconia implants sandblasted zirconia implants and SLA titanium
implants The mean RTQ for machined zirconia implants was 259 Ncm the
mean RTQ for zirconia rough implants was 405 Ncm and the mean RTQ for
SLA titanium implants was 1052 Ncm
Fracture strength within clinically acceptable limits
Stress analysis Kohal et al observed the stress distribution patterns of
zirconia implants (ReImplant) which were found to have low well distributed
and similar stress distribution compared with titanium implants
PEEK implants (poly etheretherketone)
These implants are available in three fundamentally different
designs
TAU Diameter -48 mm lengths 10 125 15 mm
immediate loading possible
Low density bone
THETA Similar to TAU but D1 bone
IOTA It is a 3mm diameter implant (10 and 12 mm)
used in narrow ridges
Advantages
Good strengthfracture resistance and bioinertness
Promotes human oseteoblast cell growth
Disadvantages
Faintly radiopaque ndashdifficult for post-op evaluation
Lengths and diameters range is restricted
Advances in
commercially
available implant
systems
LASER- LOK TECHNOLOGY
Unique surface characteristics
Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using
laser ablation technology
Extremely consistent microchannels that are optimally
sized to attach and organize both osteoblasts and
fibroblasts
Includes a repeating nanostructure that maximizes
surface area and enables cell pseudopodia and collagen
microfibrils to interdigitate with the Laser-Lok surface
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
ZONOGRAPHY
A modification of the panoramic x-ray machine for making
cross sectional images of the jaws
The tomographic layer is approximately 5mm
For appreciation of spatial relationship between the critical
structures and the implant siteLimitations
bullTomographic layers relatively thick
bullAdjacent structures blurring and superimposition
bullNot useful for determining the differences in
bone density or for identifying disease at implant
site
Tomography
Tomography is the generic name formed by the greek
words lsquotomorsquo(slice) and lsquographyrsquo(picture)
Enables visualization of a section of patientrsquos anatomy by
blurring other regions above and below the site of interest
For dental implant patients high quality complex motion
tomography is required
Computed tomography (CT)
CT was invented by Sir Godfrey Hounsfield and was introduced in
1972
Computed tomography (CT) is a digital and mathematical imaging
technique that creates tomographic sections and allows soft tissues
and hard tissues to be visualized simultaneously
Ideally tomographic sections spaced 1 to 2 mm enable evaluation of
implant site and 3D appearance of alveolus
With latest CT scanners images with sectional thickness of 025 mm
can be obtained
The advantages of CT based systems are
Uniform magnification
High contrast image with well-defined image layer free of
blurring
Easier identification of bone grafts or hydroxyappatite materials
used to augment maxillary bone in sinus region
Multiplanar views
Three-dimensional reconstruction
Simultaneous study of multiple implant sites
Availability of soft tissue for image analysis
Disadvantages
Limited availability of reconstructive software
Higher dose of radiation
Lack of understanding of dentists
Lack of usefulness for implant interface follow-up because of
metallic streak artifacts
Expense
Recent advances in Computed Tomography(CT)
Tuned Aperture CT (TACT)
Tuned aperture computed tomography (TACT) by Webber is a
relatively simple faster method for reconstructing tomographic
images
It is based on the concept of tomo-synthesis and optical-aperture
theory
TACT uses 2-D periapical radiographs acquired from different
projection angles as base images and permits retrospective
generation of longitudinal tomographic slices (TACT-S) lining up in
the Z axis of the area of interest
The overall radiation dose of TACT is not greater than 1 to 2 times
that of a conventional periapical X-ray film
The resolution is stated to be similar with 2-D radiographs
Artefacts associated with CT such as starburst patterns seen with
metallic restorations do not exist with TACT
The big conceptCone Bean Computed Tomography
Cone Beam Computed Tomography
Fan beam Cone beam
Software programs incorporating sophisticated
algorithms including back-filtered projection are applied
to these image data to generate a 3D volumetric data set
which can be used to provide primary reconstruction
images in 3 orthogonal planes (axial sagittal and coronal)
CBCT is devoted to maxillofacial area to scan and
visualize jaw bone lesions especially cancellous bone
It gives all the information of a CT but at 18th the
radiation dose and at a lower cost
CBCT is categorized into large medium and limited volume units based on the size
of their field of view (FOV)
Large (FOV)
bull 15-23 cm
bull Maxillofacial trauma
bull Orthodontic use
bull TMJ diseases
Medium FOV
bull 10-15 cm
bull Mandibulo-maxillary imaging
bull Pre-implant planning
bull Pathology
Small FOV
bull lt 10 cm
bull Endodontic applications
Advantages of CBCT
X-ray beam limitation
Image accuracy
Rapid scan time 10ndash70 seconds
Software can be made available to the user
Dose reduction Effective dose is 98 smaller than conventional CT
Reduced image artifact
Interactive computed tomography(ICT)
bullThis technique enables transfer of the imaging study to the
clinician as a computer filehellip
bullThe clinicianrsquos computer becomes a diagnostic radiologic
workstation with tools
bullAn important feature of ICT is that the clinician and radiologist can
perform ldquoelectronic surgeryrdquo (ES)
bull With an appropriately designed diagnostic
template ES can be performed to develop
the patientrsquos treatment plan electronically in
3 dimensions
bullTransfer of the plan to the patient at the
time of surgery can be accomplished by
production of the computer generated
three-dimensional stereotactic surgical
templates
Recent advances in
Computed Tomography(CT)
Microtomograph
Modification of CT it is specially useful in acquiring serial sections of bone
implant interface
Multi slice helical CT
The helical CT scan takes continuous pictures of the body in a rapid spiral motion
so that there are no gaps in the pictures collected
Recent Advances
in Implant Design
Mini implants
Mini dental implants (MDIs) are small diameter dental implants
Are sometimes referred to as SDIs (small diameter implants) as
well as NDIs (narrow body implants)
Diameter 18mm to 29mm (less than 3mm)
Various lengths 10 13 15 amp 18 mmrsquos
The MDI are available with either an O-ball head for use with
removable or fixed dentures or a square head for fixed prostheses or
retrofitting a poorly adapted partial denture
The body connects the tip with the prosthetic head and can be a
parallel sided cylinder or a progressively tapered cone
A small pilot bit is used to create the opening for the implant to be
threaded into the bone
The definitive implant supported crowns are usually delivered
within 2 weeks of surgery
Advantages
Immediate loading
Can be inserted in minimal tissues without relying on grafting
techniques
Minimally invasive procedure
One-stage denture stabilization
Does not require osteotomy
Cost-effective
Can be placed with a simple technique in patients with ridge too
narrow for conventional implants
Narrow-diameter implants Are they a predictable
treatment option A literature review
Joseacute-Luis Sierra-Saacutenchez Med Oral Patol Oral Cir Bucal 2014
Jan 119 (1)e74-81
The review included
Four randomized clinical trials
Ten prospective studies
Seven retrospective studies
The follow-up periods -12 months to 12 years
Total of 1607 patients
The patient age - 13 to 87 years
2980 implants
The recorded implant survival rates were above 90 in all the
studies Six studies published a survival rate of 100 at the end of
the follow-up period
The lowest survival rate (909) corresponded to the study
published by Barter et al
58 failures (implant loss) were recorded out of a total of 2980
implants
A larger number of failures were recorded with implants measuring
le 13 mm in length
Nineteen studies measured changes in peri-implant bone height
after implant loading 0065 mm the first year to 174 mm after a
follow-up period of 10 years
Araujo published a retrospective study on 33 mm implants placed
in posterior areas and rehabilitated following an immediate loading
protocol
Implant survival rate was 955 after 9 years of follow-up
That same year Degidi et al published a study comparing delayed
and immediate loading in narrow-diameter implants placed in both
anterior and posterior zones
Survival rate was 994 after a mean follow-up of 20 months
TRANSITIONAL IMPLANTS
Diameter ranges -18 to 28 mm
Length -7mm to 14mm
Fabricated with pure titanium in a single body with treated
surface
Primary function is to absorb masticatory stress during healing
phase
They should be placed at least 15 mm from adjacent teeth and
the distance between any transitional implant and a definitive
implant must be at least 15-2 mm
The abutment head generally has a 5 degree taper which makes it
optimal for retention of cement retained prostheses
Only one drill a 15 mm or 2 mm twist drill is required for
placement of the implants
Advantages
Provisionalisation of fully and partially edentulous jaws
Undisturbed healing of bone grafts
Effective way to generate aesthetic transitional appliances
Allows evaluation of phonetics and function
Cost effective
One ndash Piece Implants
The implant is machined from a piece of titanium that
incorporates both the implant body and an integral fixed abutment
in a single component
3 diameters -35 43 and 5 mm
4 lengths -10 13 15 and 16 mm
Clinical and radiographic evaluation of one-piece implants
used for immediate function
Jack a Hahn journal of oral implantology vol 33(3)2007
The aim of the present research was to evaluate the radiographic
outcome of a 1-piece implant when used for immediate function in
an ordinary patient pool
Forty-seven NobelDirect and NobelPerfect 1-piece implants
(Nobel Biocare Goumlteborg Sweden) were placed in maxillae and
mandibles
In this study 1 of the 47 implants had to be removed resulting in a
cumulative implant survival rate of 979 throughout the follow-up
period
The mean marginal bone level relative to the reference point after
1 year of loading (078 - 160 mm) as well as after 2 and 3 years of
loading was located above the first implant thread
In this study a bone level 2 mm apical to the reference point after
1 year of loading was observed at 2 implants (6)
The 1-piece implant design enables undisturbed healing
of the peri-implant soft tissue and avoids disruption of the
soft tissue seal when placing the definitive prosthetic
restoration
Annibali et al reported a series of patients treated
consecutively for first molar replacement according to
Immediate = group 1
Early = group 2
Late = Group 3
The implant survival rate
917 for early implants
950 for immediate post-extraction implants
100 for implants placed in healed sites
Short Dental Implants
A dental implant with length of 7 mm or less (Friberg et al 2000)
Any implant under 10 mm in length referred to as a lsquolsquoshortrsquorsquo
implant (Griffin TJ Cheung WS 2004)
A device with an intra-bony length of 8 mm or less (Renouard
and Nisand 2006)
Indication
Atropic Jaw
Proximity to vital structure
Single crowns
Overdentures
Advantages
1 Bone grafting for height often unnecessary
2 Less money pain and time prior to restoration of the implant
3 Simplified bone surgery
4 Implant insertion easier
Goodacre et al in 2003 reviewed
2754 implants - lt10 mm
3015 implants - gt10 mm in length
The failure rate of implants 10 mm or less was 10 compared
to a 3 failure rate of implants longer than 10 mm
Ivanoff et al in 1999 found an 8-mm-long 5-mm-diameter
implant failed 25 of the time in the maxilla and 33 of the
time in the mandible On the other hand the 10-mm and 12-
mm implants that were 5 mm in diameter reported no
mandibular failure and a 10 failure in the maxilla
Misch CE Short Dental Implants A Literature Review and Rationale for Use Dent Today 2005 Aug24(8)64-6 68
On the other hand a retrospective report by Misch et al was compiled
from 2 private offices using a square thread implant body design
(BioHorizons) rather than a v-shaped thread as primarily reported in the
previous literature
During a 3-year period 126 patients received implants less than 10 mm
long
Of the 437 implants there were 3 implant failures in the posterior
mandible and 1 failure in the posterior maxilla (99 survival)
All these failures were implants 9 mm long and 4 mm in diameter
Advances in Implant materials
Previously implants had macro-irregularities like macroscopic
threads fenestrations pores grooves steps threads or other
surface irregularities that were visible
However difficulty in achieving initial stability post implantation
relative motion adverse interfacial bone remodelling all lead to
search for improvement of the surface quality of a titanium dental
implant
BLASTING
Blasting -aluminium oxide titanium oxide and calcium phosphate
with particle size ranging from small medium to large (150- 350
microm)
Blasting a smooth Ti surface with Al2 O3 particles of 25 microm 75 microm
or 250 microm produces surfaces with roughness values of 116 to 120
143 and 194 to 220 respectively
A series of investigations have demonstrated a firmer bone
fixation of the implant with an average surface roughness (sa) of 1-
15microm than those of smoother implants with an average surface
roughness of 06microm
Blasting and Acid Etching
Acid etching can be done by using an HCL H2 SO4 mixture or by
pickling in 2 HF10HNO3 These processes leave pits and craters
Alumina or TiO2 for blasting the surface
Small - 25μm
large grit -025-05mm
medium grit - 250-500μm
Sand blasted and acid etched surfaces have a hydrophobic surface
The etching leads to the formation of Titanium hydrides and the
replacement of hydride by oxygen results in the slow transformation of
the implant surface resulting in nanometre sized particles of titanium on
the surface which helps in protein adhesion on implant surface
Dual acid etching with HCl and H2SO4 heated above 100ᴼC has
produced surface topography able to attach to fibrin scaffold and
promote adhesion of osteogenic cells
Sand blasting and etching can increase the rate and amount of the
bone formation
Flouride Surface Treatments
This treatment enhances osseointegration and osteoblastic
differentitation with increased expression of Cbfa1 osterix and
bone sialoprotein
Fluoridated rough implants also withstood greater push-out
forces and showed a significantly higher removal torque than
control implants
However detrimental effect of F on the corrosion resistance of
titanium and titanium alloys has been extensively reported
Anodized Surface Implants
Anodized surface implants are implants which are placed as anodes
in galvanic cells with phosphoric acid as the electrolyte and current is
passed through them ndash also ca ldquoTiunite surfacerdquo
The surface oxides grow from the native state of 5nm to
approximately 10000nm
The sa of TiUnite is reported to be 11microm and its sdr 37
Anodic oxidation results in the growth of a native titanium oxide
layer and a porous topography with the bone formation occurring
directly on the moderately rough oxidized surface
Clinical and Radiographic Evaluation of Braringnemark Implants with an
Anodized Surface following Seven-to-Eight Years of Functional Loading
David Gelb Bradley McaAllister et al Int J Dent 2013 2013 583567
The aim of this study was to evaluate the clinical and
radiographic long-term outcomes of dental implants with an
anodized TiUnite surface placed in routine clinical practice
38 single prosthesis
22 FPDs
80 implants in maxilla
27 in mandible
Mean marginal bone level change-149 plusmn 103 mm
907 of cases- no visible plaque93 -visible plaque
No prosthetic complication
Calandriello evaluated immediately placed anodized
implants in 33 patients and found a mean marginal bone
loss of 117thinspmm after 5 years
Friberg and Jemt compared 280 TiUnite implants to 110
machined implants in 111 patients and found marginal
bone loss after 5 years to be 075 and 06thinspmm respectively
with no significant difference between the two types of
implants
Laser etching and Micro Arc Oxidation
After the implants are ultrasonically cleaned they are laser etched
by using an NdYAG laser at a power of 50kw frequency of 75khz
and 164A current
They are then processed in an electrolyte solution with 35
glyceroposphate disodium salt pentahydrate and 12 calcium
acetate monohydrate by microarc oxidation (voltage 350v
frequency 800hz) for 15 seconds
Microarc oxidation produces a titania film with a porous structure
and micropores of 1-5microm
The mechanism of osseointegration of the oxidized implants has
been shown to be mechanical interlocking and biochemical
bonding
Surface coating Ti Plasma Spray
Porous rough Ti surface have been fabricated by plasma
spraying a Ti powder form of molten droplets at high temperature
at temperature in order of 15000C at 600ms
The Ti plasma spray after solidification often provides 004 ndash 005
mm thickness
Ti A spray has been reported to increase the surface area of bone
to implant interface (as much as 600) and stimulate adhesion
osteogenesis
Advantages
Enhance attachment by increasing ionic interactions
Increased load bearing capability by 25-30
Increased tensile strength through ingrowth of bony tissues into 3D feature
Disadvantages
Cracking and scaling of coating because of stresses produced by elevated temprature processing
Risk of accumulation of abraded material in the interface zone during implantation of TPS
Hydroxyapatite coatings
Hydroxyapatite [Ca10(PO4)6OH]2 coating was brought to the
dental profession by DeGroot
HA forms a strong chemical bond with bone due to the presence
of free calcium and phosphate compounds at the implant surface
The HA coating consists of amorphous and crystalline forms with
a large density of cracks
The top 1-2 microm of the HA layer being amorphous while the rest
of the crystalline layer is hexagonally packed
Indicated Fresh extraction sites
Newly grafted sites
Advantages
1 Protection of surrounding bone against metal ion release from the
substrate
2 Reported chemical bonding between HA and living bone-intimate
contact-biointegration
3 Partial dissolution of HA makes surrounding fluid rich in calcium
and phosphate ions which trigger cellular differentiation and bone
formation
Disadvantages
Induction of impurities due to thermal decomposition during
processing- affecting long term clinical fixation
Dissolution of HA at lower pH
HA coating on the implant surface (50-70microm) by various methods
1 Plasma spraying
2 The vacuum deposition technique(ion beam sputtering radiofrequency
sputtering)
3 The sol gel and dip coating method
4 Electrolytic process
Nanotitania coatings
Nanotitania coatings were prepared by using the sol-gel
technique
Nanotitania implants had an increased feature density and a large
feature coverage area as compared to the nano-HA implants
This could present more binding sites for the protein cell
attachment and for increased bone contact
he Nanotitania implants exhibited an ordered arrangement
forming a homogenous layer on underlying topography
Biologically active drugs incorporated dental
implants
Bisphosphonates Bisphosphate-loaded implant surfaces have
been reported to improve implant osseointegration
Simvastatin
Simvastatin could induce the expression of bone morphogenetic
protein (BMP) mRNA that might promote bone formation and
increase bone mineral density
Gentamycin along with the layer of HA can be coated onto the
implant surface which may act as a local prophylactic agent along
with the systemic antibiotics in dental implant surgery
Biochemical Methods
of the Surface
Modifications
Biochemical Methods of the Surface
Modifications
Their goal is to immobilize proteins enzymes or peptides on
biomaterials for the purpose of inducing specific cell and tissue
responses
1 One approach uses cell-adhesion molecules like fibronectin
vitronectin Type I collagen osteogenin and bone sialoprotein
2 The second approach uses biomolecules with osteotropic
effects which range from mitogenicity (interleukin growth
factor-I FGF-2 platelet derived growth factor ndashBB) to the
increasing activity of the bone cells which enhances the
collagen synthesis for osteoinduction
Zirconia implants
Zirconia (Zr02) is a ceramic material used in implantology because
Biocompatibility(bio inert)
Esthetics (because its colour is similar to the teeth) and
Mechanical properties which are better than alumina
High resistance to corrosion flexion and fracture
Contact with bone and soft tissue similar to that observed in
titanium implants
It can be used to produce a entire implant or as a coating
Advantages of Zirconia Dental Implants
No dark colour of the metal showing through the gums
No corrosion of the zirconia as with titanium
No piezo-electric currents between dissimilar metal in
the mouth
It is thermally non-conductive
Greater BIC (Bone ndash Implant Contact)
20 more bone apposition than titanium implants
Zeynep Ouml zkurt Zirconia Dental Implants A Literature Review Journal of Oral Implantology Vol 37(3)2011
RTQ (removal torque testing) Gahlert et al evaluated the RTQ values of
machined zirconia implants sandblasted zirconia implants and SLA titanium
implants The mean RTQ for machined zirconia implants was 259 Ncm the
mean RTQ for zirconia rough implants was 405 Ncm and the mean RTQ for
SLA titanium implants was 1052 Ncm
Fracture strength within clinically acceptable limits
Stress analysis Kohal et al observed the stress distribution patterns of
zirconia implants (ReImplant) which were found to have low well distributed
and similar stress distribution compared with titanium implants
PEEK implants (poly etheretherketone)
These implants are available in three fundamentally different
designs
TAU Diameter -48 mm lengths 10 125 15 mm
immediate loading possible
Low density bone
THETA Similar to TAU but D1 bone
IOTA It is a 3mm diameter implant (10 and 12 mm)
used in narrow ridges
Advantages
Good strengthfracture resistance and bioinertness
Promotes human oseteoblast cell growth
Disadvantages
Faintly radiopaque ndashdifficult for post-op evaluation
Lengths and diameters range is restricted
Advances in
commercially
available implant
systems
LASER- LOK TECHNOLOGY
Unique surface characteristics
Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using
laser ablation technology
Extremely consistent microchannels that are optimally
sized to attach and organize both osteoblasts and
fibroblasts
Includes a repeating nanostructure that maximizes
surface area and enables cell pseudopodia and collagen
microfibrils to interdigitate with the Laser-Lok surface
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Tomography
Tomography is the generic name formed by the greek
words lsquotomorsquo(slice) and lsquographyrsquo(picture)
Enables visualization of a section of patientrsquos anatomy by
blurring other regions above and below the site of interest
For dental implant patients high quality complex motion
tomography is required
Computed tomography (CT)
CT was invented by Sir Godfrey Hounsfield and was introduced in
1972
Computed tomography (CT) is a digital and mathematical imaging
technique that creates tomographic sections and allows soft tissues
and hard tissues to be visualized simultaneously
Ideally tomographic sections spaced 1 to 2 mm enable evaluation of
implant site and 3D appearance of alveolus
With latest CT scanners images with sectional thickness of 025 mm
can be obtained
The advantages of CT based systems are
Uniform magnification
High contrast image with well-defined image layer free of
blurring
Easier identification of bone grafts or hydroxyappatite materials
used to augment maxillary bone in sinus region
Multiplanar views
Three-dimensional reconstruction
Simultaneous study of multiple implant sites
Availability of soft tissue for image analysis
Disadvantages
Limited availability of reconstructive software
Higher dose of radiation
Lack of understanding of dentists
Lack of usefulness for implant interface follow-up because of
metallic streak artifacts
Expense
Recent advances in Computed Tomography(CT)
Tuned Aperture CT (TACT)
Tuned aperture computed tomography (TACT) by Webber is a
relatively simple faster method for reconstructing tomographic
images
It is based on the concept of tomo-synthesis and optical-aperture
theory
TACT uses 2-D periapical radiographs acquired from different
projection angles as base images and permits retrospective
generation of longitudinal tomographic slices (TACT-S) lining up in
the Z axis of the area of interest
The overall radiation dose of TACT is not greater than 1 to 2 times
that of a conventional periapical X-ray film
The resolution is stated to be similar with 2-D radiographs
Artefacts associated with CT such as starburst patterns seen with
metallic restorations do not exist with TACT
The big conceptCone Bean Computed Tomography
Cone Beam Computed Tomography
Fan beam Cone beam
Software programs incorporating sophisticated
algorithms including back-filtered projection are applied
to these image data to generate a 3D volumetric data set
which can be used to provide primary reconstruction
images in 3 orthogonal planes (axial sagittal and coronal)
CBCT is devoted to maxillofacial area to scan and
visualize jaw bone lesions especially cancellous bone
It gives all the information of a CT but at 18th the
radiation dose and at a lower cost
CBCT is categorized into large medium and limited volume units based on the size
of their field of view (FOV)
Large (FOV)
bull 15-23 cm
bull Maxillofacial trauma
bull Orthodontic use
bull TMJ diseases
Medium FOV
bull 10-15 cm
bull Mandibulo-maxillary imaging
bull Pre-implant planning
bull Pathology
Small FOV
bull lt 10 cm
bull Endodontic applications
Advantages of CBCT
X-ray beam limitation
Image accuracy
Rapid scan time 10ndash70 seconds
Software can be made available to the user
Dose reduction Effective dose is 98 smaller than conventional CT
Reduced image artifact
Interactive computed tomography(ICT)
bullThis technique enables transfer of the imaging study to the
clinician as a computer filehellip
bullThe clinicianrsquos computer becomes a diagnostic radiologic
workstation with tools
bullAn important feature of ICT is that the clinician and radiologist can
perform ldquoelectronic surgeryrdquo (ES)
bull With an appropriately designed diagnostic
template ES can be performed to develop
the patientrsquos treatment plan electronically in
3 dimensions
bullTransfer of the plan to the patient at the
time of surgery can be accomplished by
production of the computer generated
three-dimensional stereotactic surgical
templates
Recent advances in
Computed Tomography(CT)
Microtomograph
Modification of CT it is specially useful in acquiring serial sections of bone
implant interface
Multi slice helical CT
The helical CT scan takes continuous pictures of the body in a rapid spiral motion
so that there are no gaps in the pictures collected
Recent Advances
in Implant Design
Mini implants
Mini dental implants (MDIs) are small diameter dental implants
Are sometimes referred to as SDIs (small diameter implants) as
well as NDIs (narrow body implants)
Diameter 18mm to 29mm (less than 3mm)
Various lengths 10 13 15 amp 18 mmrsquos
The MDI are available with either an O-ball head for use with
removable or fixed dentures or a square head for fixed prostheses or
retrofitting a poorly adapted partial denture
The body connects the tip with the prosthetic head and can be a
parallel sided cylinder or a progressively tapered cone
A small pilot bit is used to create the opening for the implant to be
threaded into the bone
The definitive implant supported crowns are usually delivered
within 2 weeks of surgery
Advantages
Immediate loading
Can be inserted in minimal tissues without relying on grafting
techniques
Minimally invasive procedure
One-stage denture stabilization
Does not require osteotomy
Cost-effective
Can be placed with a simple technique in patients with ridge too
narrow for conventional implants
Narrow-diameter implants Are they a predictable
treatment option A literature review
Joseacute-Luis Sierra-Saacutenchez Med Oral Patol Oral Cir Bucal 2014
Jan 119 (1)e74-81
The review included
Four randomized clinical trials
Ten prospective studies
Seven retrospective studies
The follow-up periods -12 months to 12 years
Total of 1607 patients
The patient age - 13 to 87 years
2980 implants
The recorded implant survival rates were above 90 in all the
studies Six studies published a survival rate of 100 at the end of
the follow-up period
The lowest survival rate (909) corresponded to the study
published by Barter et al
58 failures (implant loss) were recorded out of a total of 2980
implants
A larger number of failures were recorded with implants measuring
le 13 mm in length
Nineteen studies measured changes in peri-implant bone height
after implant loading 0065 mm the first year to 174 mm after a
follow-up period of 10 years
Araujo published a retrospective study on 33 mm implants placed
in posterior areas and rehabilitated following an immediate loading
protocol
Implant survival rate was 955 after 9 years of follow-up
That same year Degidi et al published a study comparing delayed
and immediate loading in narrow-diameter implants placed in both
anterior and posterior zones
Survival rate was 994 after a mean follow-up of 20 months
TRANSITIONAL IMPLANTS
Diameter ranges -18 to 28 mm
Length -7mm to 14mm
Fabricated with pure titanium in a single body with treated
surface
Primary function is to absorb masticatory stress during healing
phase
They should be placed at least 15 mm from adjacent teeth and
the distance between any transitional implant and a definitive
implant must be at least 15-2 mm
The abutment head generally has a 5 degree taper which makes it
optimal for retention of cement retained prostheses
Only one drill a 15 mm or 2 mm twist drill is required for
placement of the implants
Advantages
Provisionalisation of fully and partially edentulous jaws
Undisturbed healing of bone grafts
Effective way to generate aesthetic transitional appliances
Allows evaluation of phonetics and function
Cost effective
One ndash Piece Implants
The implant is machined from a piece of titanium that
incorporates both the implant body and an integral fixed abutment
in a single component
3 diameters -35 43 and 5 mm
4 lengths -10 13 15 and 16 mm
Clinical and radiographic evaluation of one-piece implants
used for immediate function
Jack a Hahn journal of oral implantology vol 33(3)2007
The aim of the present research was to evaluate the radiographic
outcome of a 1-piece implant when used for immediate function in
an ordinary patient pool
Forty-seven NobelDirect and NobelPerfect 1-piece implants
(Nobel Biocare Goumlteborg Sweden) were placed in maxillae and
mandibles
In this study 1 of the 47 implants had to be removed resulting in a
cumulative implant survival rate of 979 throughout the follow-up
period
The mean marginal bone level relative to the reference point after
1 year of loading (078 - 160 mm) as well as after 2 and 3 years of
loading was located above the first implant thread
In this study a bone level 2 mm apical to the reference point after
1 year of loading was observed at 2 implants (6)
The 1-piece implant design enables undisturbed healing
of the peri-implant soft tissue and avoids disruption of the
soft tissue seal when placing the definitive prosthetic
restoration
Annibali et al reported a series of patients treated
consecutively for first molar replacement according to
Immediate = group 1
Early = group 2
Late = Group 3
The implant survival rate
917 for early implants
950 for immediate post-extraction implants
100 for implants placed in healed sites
Short Dental Implants
A dental implant with length of 7 mm or less (Friberg et al 2000)
Any implant under 10 mm in length referred to as a lsquolsquoshortrsquorsquo
implant (Griffin TJ Cheung WS 2004)
A device with an intra-bony length of 8 mm or less (Renouard
and Nisand 2006)
Indication
Atropic Jaw
Proximity to vital structure
Single crowns
Overdentures
Advantages
1 Bone grafting for height often unnecessary
2 Less money pain and time prior to restoration of the implant
3 Simplified bone surgery
4 Implant insertion easier
Goodacre et al in 2003 reviewed
2754 implants - lt10 mm
3015 implants - gt10 mm in length
The failure rate of implants 10 mm or less was 10 compared
to a 3 failure rate of implants longer than 10 mm
Ivanoff et al in 1999 found an 8-mm-long 5-mm-diameter
implant failed 25 of the time in the maxilla and 33 of the
time in the mandible On the other hand the 10-mm and 12-
mm implants that were 5 mm in diameter reported no
mandibular failure and a 10 failure in the maxilla
Misch CE Short Dental Implants A Literature Review and Rationale for Use Dent Today 2005 Aug24(8)64-6 68
On the other hand a retrospective report by Misch et al was compiled
from 2 private offices using a square thread implant body design
(BioHorizons) rather than a v-shaped thread as primarily reported in the
previous literature
During a 3-year period 126 patients received implants less than 10 mm
long
Of the 437 implants there were 3 implant failures in the posterior
mandible and 1 failure in the posterior maxilla (99 survival)
All these failures were implants 9 mm long and 4 mm in diameter
Advances in Implant materials
Previously implants had macro-irregularities like macroscopic
threads fenestrations pores grooves steps threads or other
surface irregularities that were visible
However difficulty in achieving initial stability post implantation
relative motion adverse interfacial bone remodelling all lead to
search for improvement of the surface quality of a titanium dental
implant
BLASTING
Blasting -aluminium oxide titanium oxide and calcium phosphate
with particle size ranging from small medium to large (150- 350
microm)
Blasting a smooth Ti surface with Al2 O3 particles of 25 microm 75 microm
or 250 microm produces surfaces with roughness values of 116 to 120
143 and 194 to 220 respectively
A series of investigations have demonstrated a firmer bone
fixation of the implant with an average surface roughness (sa) of 1-
15microm than those of smoother implants with an average surface
roughness of 06microm
Blasting and Acid Etching
Acid etching can be done by using an HCL H2 SO4 mixture or by
pickling in 2 HF10HNO3 These processes leave pits and craters
Alumina or TiO2 for blasting the surface
Small - 25μm
large grit -025-05mm
medium grit - 250-500μm
Sand blasted and acid etched surfaces have a hydrophobic surface
The etching leads to the formation of Titanium hydrides and the
replacement of hydride by oxygen results in the slow transformation of
the implant surface resulting in nanometre sized particles of titanium on
the surface which helps in protein adhesion on implant surface
Dual acid etching with HCl and H2SO4 heated above 100ᴼC has
produced surface topography able to attach to fibrin scaffold and
promote adhesion of osteogenic cells
Sand blasting and etching can increase the rate and amount of the
bone formation
Flouride Surface Treatments
This treatment enhances osseointegration and osteoblastic
differentitation with increased expression of Cbfa1 osterix and
bone sialoprotein
Fluoridated rough implants also withstood greater push-out
forces and showed a significantly higher removal torque than
control implants
However detrimental effect of F on the corrosion resistance of
titanium and titanium alloys has been extensively reported
Anodized Surface Implants
Anodized surface implants are implants which are placed as anodes
in galvanic cells with phosphoric acid as the electrolyte and current is
passed through them ndash also ca ldquoTiunite surfacerdquo
The surface oxides grow from the native state of 5nm to
approximately 10000nm
The sa of TiUnite is reported to be 11microm and its sdr 37
Anodic oxidation results in the growth of a native titanium oxide
layer and a porous topography with the bone formation occurring
directly on the moderately rough oxidized surface
Clinical and Radiographic Evaluation of Braringnemark Implants with an
Anodized Surface following Seven-to-Eight Years of Functional Loading
David Gelb Bradley McaAllister et al Int J Dent 2013 2013 583567
The aim of this study was to evaluate the clinical and
radiographic long-term outcomes of dental implants with an
anodized TiUnite surface placed in routine clinical practice
38 single prosthesis
22 FPDs
80 implants in maxilla
27 in mandible
Mean marginal bone level change-149 plusmn 103 mm
907 of cases- no visible plaque93 -visible plaque
No prosthetic complication
Calandriello evaluated immediately placed anodized
implants in 33 patients and found a mean marginal bone
loss of 117thinspmm after 5 years
Friberg and Jemt compared 280 TiUnite implants to 110
machined implants in 111 patients and found marginal
bone loss after 5 years to be 075 and 06thinspmm respectively
with no significant difference between the two types of
implants
Laser etching and Micro Arc Oxidation
After the implants are ultrasonically cleaned they are laser etched
by using an NdYAG laser at a power of 50kw frequency of 75khz
and 164A current
They are then processed in an electrolyte solution with 35
glyceroposphate disodium salt pentahydrate and 12 calcium
acetate monohydrate by microarc oxidation (voltage 350v
frequency 800hz) for 15 seconds
Microarc oxidation produces a titania film with a porous structure
and micropores of 1-5microm
The mechanism of osseointegration of the oxidized implants has
been shown to be mechanical interlocking and biochemical
bonding
Surface coating Ti Plasma Spray
Porous rough Ti surface have been fabricated by plasma
spraying a Ti powder form of molten droplets at high temperature
at temperature in order of 15000C at 600ms
The Ti plasma spray after solidification often provides 004 ndash 005
mm thickness
Ti A spray has been reported to increase the surface area of bone
to implant interface (as much as 600) and stimulate adhesion
osteogenesis
Advantages
Enhance attachment by increasing ionic interactions
Increased load bearing capability by 25-30
Increased tensile strength through ingrowth of bony tissues into 3D feature
Disadvantages
Cracking and scaling of coating because of stresses produced by elevated temprature processing
Risk of accumulation of abraded material in the interface zone during implantation of TPS
Hydroxyapatite coatings
Hydroxyapatite [Ca10(PO4)6OH]2 coating was brought to the
dental profession by DeGroot
HA forms a strong chemical bond with bone due to the presence
of free calcium and phosphate compounds at the implant surface
The HA coating consists of amorphous and crystalline forms with
a large density of cracks
The top 1-2 microm of the HA layer being amorphous while the rest
of the crystalline layer is hexagonally packed
Indicated Fresh extraction sites
Newly grafted sites
Advantages
1 Protection of surrounding bone against metal ion release from the
substrate
2 Reported chemical bonding between HA and living bone-intimate
contact-biointegration
3 Partial dissolution of HA makes surrounding fluid rich in calcium
and phosphate ions which trigger cellular differentiation and bone
formation
Disadvantages
Induction of impurities due to thermal decomposition during
processing- affecting long term clinical fixation
Dissolution of HA at lower pH
HA coating on the implant surface (50-70microm) by various methods
1 Plasma spraying
2 The vacuum deposition technique(ion beam sputtering radiofrequency
sputtering)
3 The sol gel and dip coating method
4 Electrolytic process
Nanotitania coatings
Nanotitania coatings were prepared by using the sol-gel
technique
Nanotitania implants had an increased feature density and a large
feature coverage area as compared to the nano-HA implants
This could present more binding sites for the protein cell
attachment and for increased bone contact
he Nanotitania implants exhibited an ordered arrangement
forming a homogenous layer on underlying topography
Biologically active drugs incorporated dental
implants
Bisphosphonates Bisphosphate-loaded implant surfaces have
been reported to improve implant osseointegration
Simvastatin
Simvastatin could induce the expression of bone morphogenetic
protein (BMP) mRNA that might promote bone formation and
increase bone mineral density
Gentamycin along with the layer of HA can be coated onto the
implant surface which may act as a local prophylactic agent along
with the systemic antibiotics in dental implant surgery
Biochemical Methods
of the Surface
Modifications
Biochemical Methods of the Surface
Modifications
Their goal is to immobilize proteins enzymes or peptides on
biomaterials for the purpose of inducing specific cell and tissue
responses
1 One approach uses cell-adhesion molecules like fibronectin
vitronectin Type I collagen osteogenin and bone sialoprotein
2 The second approach uses biomolecules with osteotropic
effects which range from mitogenicity (interleukin growth
factor-I FGF-2 platelet derived growth factor ndashBB) to the
increasing activity of the bone cells which enhances the
collagen synthesis for osteoinduction
Zirconia implants
Zirconia (Zr02) is a ceramic material used in implantology because
Biocompatibility(bio inert)
Esthetics (because its colour is similar to the teeth) and
Mechanical properties which are better than alumina
High resistance to corrosion flexion and fracture
Contact with bone and soft tissue similar to that observed in
titanium implants
It can be used to produce a entire implant or as a coating
Advantages of Zirconia Dental Implants
No dark colour of the metal showing through the gums
No corrosion of the zirconia as with titanium
No piezo-electric currents between dissimilar metal in
the mouth
It is thermally non-conductive
Greater BIC (Bone ndash Implant Contact)
20 more bone apposition than titanium implants
Zeynep Ouml zkurt Zirconia Dental Implants A Literature Review Journal of Oral Implantology Vol 37(3)2011
RTQ (removal torque testing) Gahlert et al evaluated the RTQ values of
machined zirconia implants sandblasted zirconia implants and SLA titanium
implants The mean RTQ for machined zirconia implants was 259 Ncm the
mean RTQ for zirconia rough implants was 405 Ncm and the mean RTQ for
SLA titanium implants was 1052 Ncm
Fracture strength within clinically acceptable limits
Stress analysis Kohal et al observed the stress distribution patterns of
zirconia implants (ReImplant) which were found to have low well distributed
and similar stress distribution compared with titanium implants
PEEK implants (poly etheretherketone)
These implants are available in three fundamentally different
designs
TAU Diameter -48 mm lengths 10 125 15 mm
immediate loading possible
Low density bone
THETA Similar to TAU but D1 bone
IOTA It is a 3mm diameter implant (10 and 12 mm)
used in narrow ridges
Advantages
Good strengthfracture resistance and bioinertness
Promotes human oseteoblast cell growth
Disadvantages
Faintly radiopaque ndashdifficult for post-op evaluation
Lengths and diameters range is restricted
Advances in
commercially
available implant
systems
LASER- LOK TECHNOLOGY
Unique surface characteristics
Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using
laser ablation technology
Extremely consistent microchannels that are optimally
sized to attach and organize both osteoblasts and
fibroblasts
Includes a repeating nanostructure that maximizes
surface area and enables cell pseudopodia and collagen
microfibrils to interdigitate with the Laser-Lok surface
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Computed tomography (CT)
CT was invented by Sir Godfrey Hounsfield and was introduced in
1972
Computed tomography (CT) is a digital and mathematical imaging
technique that creates tomographic sections and allows soft tissues
and hard tissues to be visualized simultaneously
Ideally tomographic sections spaced 1 to 2 mm enable evaluation of
implant site and 3D appearance of alveolus
With latest CT scanners images with sectional thickness of 025 mm
can be obtained
The advantages of CT based systems are
Uniform magnification
High contrast image with well-defined image layer free of
blurring
Easier identification of bone grafts or hydroxyappatite materials
used to augment maxillary bone in sinus region
Multiplanar views
Three-dimensional reconstruction
Simultaneous study of multiple implant sites
Availability of soft tissue for image analysis
Disadvantages
Limited availability of reconstructive software
Higher dose of radiation
Lack of understanding of dentists
Lack of usefulness for implant interface follow-up because of
metallic streak artifacts
Expense
Recent advances in Computed Tomography(CT)
Tuned Aperture CT (TACT)
Tuned aperture computed tomography (TACT) by Webber is a
relatively simple faster method for reconstructing tomographic
images
It is based on the concept of tomo-synthesis and optical-aperture
theory
TACT uses 2-D periapical radiographs acquired from different
projection angles as base images and permits retrospective
generation of longitudinal tomographic slices (TACT-S) lining up in
the Z axis of the area of interest
The overall radiation dose of TACT is not greater than 1 to 2 times
that of a conventional periapical X-ray film
The resolution is stated to be similar with 2-D radiographs
Artefacts associated with CT such as starburst patterns seen with
metallic restorations do not exist with TACT
The big conceptCone Bean Computed Tomography
Cone Beam Computed Tomography
Fan beam Cone beam
Software programs incorporating sophisticated
algorithms including back-filtered projection are applied
to these image data to generate a 3D volumetric data set
which can be used to provide primary reconstruction
images in 3 orthogonal planes (axial sagittal and coronal)
CBCT is devoted to maxillofacial area to scan and
visualize jaw bone lesions especially cancellous bone
It gives all the information of a CT but at 18th the
radiation dose and at a lower cost
CBCT is categorized into large medium and limited volume units based on the size
of their field of view (FOV)
Large (FOV)
bull 15-23 cm
bull Maxillofacial trauma
bull Orthodontic use
bull TMJ diseases
Medium FOV
bull 10-15 cm
bull Mandibulo-maxillary imaging
bull Pre-implant planning
bull Pathology
Small FOV
bull lt 10 cm
bull Endodontic applications
Advantages of CBCT
X-ray beam limitation
Image accuracy
Rapid scan time 10ndash70 seconds
Software can be made available to the user
Dose reduction Effective dose is 98 smaller than conventional CT
Reduced image artifact
Interactive computed tomography(ICT)
bullThis technique enables transfer of the imaging study to the
clinician as a computer filehellip
bullThe clinicianrsquos computer becomes a diagnostic radiologic
workstation with tools
bullAn important feature of ICT is that the clinician and radiologist can
perform ldquoelectronic surgeryrdquo (ES)
bull With an appropriately designed diagnostic
template ES can be performed to develop
the patientrsquos treatment plan electronically in
3 dimensions
bullTransfer of the plan to the patient at the
time of surgery can be accomplished by
production of the computer generated
three-dimensional stereotactic surgical
templates
Recent advances in
Computed Tomography(CT)
Microtomograph
Modification of CT it is specially useful in acquiring serial sections of bone
implant interface
Multi slice helical CT
The helical CT scan takes continuous pictures of the body in a rapid spiral motion
so that there are no gaps in the pictures collected
Recent Advances
in Implant Design
Mini implants
Mini dental implants (MDIs) are small diameter dental implants
Are sometimes referred to as SDIs (small diameter implants) as
well as NDIs (narrow body implants)
Diameter 18mm to 29mm (less than 3mm)
Various lengths 10 13 15 amp 18 mmrsquos
The MDI are available with either an O-ball head for use with
removable or fixed dentures or a square head for fixed prostheses or
retrofitting a poorly adapted partial denture
The body connects the tip with the prosthetic head and can be a
parallel sided cylinder or a progressively tapered cone
A small pilot bit is used to create the opening for the implant to be
threaded into the bone
The definitive implant supported crowns are usually delivered
within 2 weeks of surgery
Advantages
Immediate loading
Can be inserted in minimal tissues without relying on grafting
techniques
Minimally invasive procedure
One-stage denture stabilization
Does not require osteotomy
Cost-effective
Can be placed with a simple technique in patients with ridge too
narrow for conventional implants
Narrow-diameter implants Are they a predictable
treatment option A literature review
Joseacute-Luis Sierra-Saacutenchez Med Oral Patol Oral Cir Bucal 2014
Jan 119 (1)e74-81
The review included
Four randomized clinical trials
Ten prospective studies
Seven retrospective studies
The follow-up periods -12 months to 12 years
Total of 1607 patients
The patient age - 13 to 87 years
2980 implants
The recorded implant survival rates were above 90 in all the
studies Six studies published a survival rate of 100 at the end of
the follow-up period
The lowest survival rate (909) corresponded to the study
published by Barter et al
58 failures (implant loss) were recorded out of a total of 2980
implants
A larger number of failures were recorded with implants measuring
le 13 mm in length
Nineteen studies measured changes in peri-implant bone height
after implant loading 0065 mm the first year to 174 mm after a
follow-up period of 10 years
Araujo published a retrospective study on 33 mm implants placed
in posterior areas and rehabilitated following an immediate loading
protocol
Implant survival rate was 955 after 9 years of follow-up
That same year Degidi et al published a study comparing delayed
and immediate loading in narrow-diameter implants placed in both
anterior and posterior zones
Survival rate was 994 after a mean follow-up of 20 months
TRANSITIONAL IMPLANTS
Diameter ranges -18 to 28 mm
Length -7mm to 14mm
Fabricated with pure titanium in a single body with treated
surface
Primary function is to absorb masticatory stress during healing
phase
They should be placed at least 15 mm from adjacent teeth and
the distance between any transitional implant and a definitive
implant must be at least 15-2 mm
The abutment head generally has a 5 degree taper which makes it
optimal for retention of cement retained prostheses
Only one drill a 15 mm or 2 mm twist drill is required for
placement of the implants
Advantages
Provisionalisation of fully and partially edentulous jaws
Undisturbed healing of bone grafts
Effective way to generate aesthetic transitional appliances
Allows evaluation of phonetics and function
Cost effective
One ndash Piece Implants
The implant is machined from a piece of titanium that
incorporates both the implant body and an integral fixed abutment
in a single component
3 diameters -35 43 and 5 mm
4 lengths -10 13 15 and 16 mm
Clinical and radiographic evaluation of one-piece implants
used for immediate function
Jack a Hahn journal of oral implantology vol 33(3)2007
The aim of the present research was to evaluate the radiographic
outcome of a 1-piece implant when used for immediate function in
an ordinary patient pool
Forty-seven NobelDirect and NobelPerfect 1-piece implants
(Nobel Biocare Goumlteborg Sweden) were placed in maxillae and
mandibles
In this study 1 of the 47 implants had to be removed resulting in a
cumulative implant survival rate of 979 throughout the follow-up
period
The mean marginal bone level relative to the reference point after
1 year of loading (078 - 160 mm) as well as after 2 and 3 years of
loading was located above the first implant thread
In this study a bone level 2 mm apical to the reference point after
1 year of loading was observed at 2 implants (6)
The 1-piece implant design enables undisturbed healing
of the peri-implant soft tissue and avoids disruption of the
soft tissue seal when placing the definitive prosthetic
restoration
Annibali et al reported a series of patients treated
consecutively for first molar replacement according to
Immediate = group 1
Early = group 2
Late = Group 3
The implant survival rate
917 for early implants
950 for immediate post-extraction implants
100 for implants placed in healed sites
Short Dental Implants
A dental implant with length of 7 mm or less (Friberg et al 2000)
Any implant under 10 mm in length referred to as a lsquolsquoshortrsquorsquo
implant (Griffin TJ Cheung WS 2004)
A device with an intra-bony length of 8 mm or less (Renouard
and Nisand 2006)
Indication
Atropic Jaw
Proximity to vital structure
Single crowns
Overdentures
Advantages
1 Bone grafting for height often unnecessary
2 Less money pain and time prior to restoration of the implant
3 Simplified bone surgery
4 Implant insertion easier
Goodacre et al in 2003 reviewed
2754 implants - lt10 mm
3015 implants - gt10 mm in length
The failure rate of implants 10 mm or less was 10 compared
to a 3 failure rate of implants longer than 10 mm
Ivanoff et al in 1999 found an 8-mm-long 5-mm-diameter
implant failed 25 of the time in the maxilla and 33 of the
time in the mandible On the other hand the 10-mm and 12-
mm implants that were 5 mm in diameter reported no
mandibular failure and a 10 failure in the maxilla
Misch CE Short Dental Implants A Literature Review and Rationale for Use Dent Today 2005 Aug24(8)64-6 68
On the other hand a retrospective report by Misch et al was compiled
from 2 private offices using a square thread implant body design
(BioHorizons) rather than a v-shaped thread as primarily reported in the
previous literature
During a 3-year period 126 patients received implants less than 10 mm
long
Of the 437 implants there were 3 implant failures in the posterior
mandible and 1 failure in the posterior maxilla (99 survival)
All these failures were implants 9 mm long and 4 mm in diameter
Advances in Implant materials
Previously implants had macro-irregularities like macroscopic
threads fenestrations pores grooves steps threads or other
surface irregularities that were visible
However difficulty in achieving initial stability post implantation
relative motion adverse interfacial bone remodelling all lead to
search for improvement of the surface quality of a titanium dental
implant
BLASTING
Blasting -aluminium oxide titanium oxide and calcium phosphate
with particle size ranging from small medium to large (150- 350
microm)
Blasting a smooth Ti surface with Al2 O3 particles of 25 microm 75 microm
or 250 microm produces surfaces with roughness values of 116 to 120
143 and 194 to 220 respectively
A series of investigations have demonstrated a firmer bone
fixation of the implant with an average surface roughness (sa) of 1-
15microm than those of smoother implants with an average surface
roughness of 06microm
Blasting and Acid Etching
Acid etching can be done by using an HCL H2 SO4 mixture or by
pickling in 2 HF10HNO3 These processes leave pits and craters
Alumina or TiO2 for blasting the surface
Small - 25μm
large grit -025-05mm
medium grit - 250-500μm
Sand blasted and acid etched surfaces have a hydrophobic surface
The etching leads to the formation of Titanium hydrides and the
replacement of hydride by oxygen results in the slow transformation of
the implant surface resulting in nanometre sized particles of titanium on
the surface which helps in protein adhesion on implant surface
Dual acid etching with HCl and H2SO4 heated above 100ᴼC has
produced surface topography able to attach to fibrin scaffold and
promote adhesion of osteogenic cells
Sand blasting and etching can increase the rate and amount of the
bone formation
Flouride Surface Treatments
This treatment enhances osseointegration and osteoblastic
differentitation with increased expression of Cbfa1 osterix and
bone sialoprotein
Fluoridated rough implants also withstood greater push-out
forces and showed a significantly higher removal torque than
control implants
However detrimental effect of F on the corrosion resistance of
titanium and titanium alloys has been extensively reported
Anodized Surface Implants
Anodized surface implants are implants which are placed as anodes
in galvanic cells with phosphoric acid as the electrolyte and current is
passed through them ndash also ca ldquoTiunite surfacerdquo
The surface oxides grow from the native state of 5nm to
approximately 10000nm
The sa of TiUnite is reported to be 11microm and its sdr 37
Anodic oxidation results in the growth of a native titanium oxide
layer and a porous topography with the bone formation occurring
directly on the moderately rough oxidized surface
Clinical and Radiographic Evaluation of Braringnemark Implants with an
Anodized Surface following Seven-to-Eight Years of Functional Loading
David Gelb Bradley McaAllister et al Int J Dent 2013 2013 583567
The aim of this study was to evaluate the clinical and
radiographic long-term outcomes of dental implants with an
anodized TiUnite surface placed in routine clinical practice
38 single prosthesis
22 FPDs
80 implants in maxilla
27 in mandible
Mean marginal bone level change-149 plusmn 103 mm
907 of cases- no visible plaque93 -visible plaque
No prosthetic complication
Calandriello evaluated immediately placed anodized
implants in 33 patients and found a mean marginal bone
loss of 117thinspmm after 5 years
Friberg and Jemt compared 280 TiUnite implants to 110
machined implants in 111 patients and found marginal
bone loss after 5 years to be 075 and 06thinspmm respectively
with no significant difference between the two types of
implants
Laser etching and Micro Arc Oxidation
After the implants are ultrasonically cleaned they are laser etched
by using an NdYAG laser at a power of 50kw frequency of 75khz
and 164A current
They are then processed in an electrolyte solution with 35
glyceroposphate disodium salt pentahydrate and 12 calcium
acetate monohydrate by microarc oxidation (voltage 350v
frequency 800hz) for 15 seconds
Microarc oxidation produces a titania film with a porous structure
and micropores of 1-5microm
The mechanism of osseointegration of the oxidized implants has
been shown to be mechanical interlocking and biochemical
bonding
Surface coating Ti Plasma Spray
Porous rough Ti surface have been fabricated by plasma
spraying a Ti powder form of molten droplets at high temperature
at temperature in order of 15000C at 600ms
The Ti plasma spray after solidification often provides 004 ndash 005
mm thickness
Ti A spray has been reported to increase the surface area of bone
to implant interface (as much as 600) and stimulate adhesion
osteogenesis
Advantages
Enhance attachment by increasing ionic interactions
Increased load bearing capability by 25-30
Increased tensile strength through ingrowth of bony tissues into 3D feature
Disadvantages
Cracking and scaling of coating because of stresses produced by elevated temprature processing
Risk of accumulation of abraded material in the interface zone during implantation of TPS
Hydroxyapatite coatings
Hydroxyapatite [Ca10(PO4)6OH]2 coating was brought to the
dental profession by DeGroot
HA forms a strong chemical bond with bone due to the presence
of free calcium and phosphate compounds at the implant surface
The HA coating consists of amorphous and crystalline forms with
a large density of cracks
The top 1-2 microm of the HA layer being amorphous while the rest
of the crystalline layer is hexagonally packed
Indicated Fresh extraction sites
Newly grafted sites
Advantages
1 Protection of surrounding bone against metal ion release from the
substrate
2 Reported chemical bonding between HA and living bone-intimate
contact-biointegration
3 Partial dissolution of HA makes surrounding fluid rich in calcium
and phosphate ions which trigger cellular differentiation and bone
formation
Disadvantages
Induction of impurities due to thermal decomposition during
processing- affecting long term clinical fixation
Dissolution of HA at lower pH
HA coating on the implant surface (50-70microm) by various methods
1 Plasma spraying
2 The vacuum deposition technique(ion beam sputtering radiofrequency
sputtering)
3 The sol gel and dip coating method
4 Electrolytic process
Nanotitania coatings
Nanotitania coatings were prepared by using the sol-gel
technique
Nanotitania implants had an increased feature density and a large
feature coverage area as compared to the nano-HA implants
This could present more binding sites for the protein cell
attachment and for increased bone contact
he Nanotitania implants exhibited an ordered arrangement
forming a homogenous layer on underlying topography
Biologically active drugs incorporated dental
implants
Bisphosphonates Bisphosphate-loaded implant surfaces have
been reported to improve implant osseointegration
Simvastatin
Simvastatin could induce the expression of bone morphogenetic
protein (BMP) mRNA that might promote bone formation and
increase bone mineral density
Gentamycin along with the layer of HA can be coated onto the
implant surface which may act as a local prophylactic agent along
with the systemic antibiotics in dental implant surgery
Biochemical Methods
of the Surface
Modifications
Biochemical Methods of the Surface
Modifications
Their goal is to immobilize proteins enzymes or peptides on
biomaterials for the purpose of inducing specific cell and tissue
responses
1 One approach uses cell-adhesion molecules like fibronectin
vitronectin Type I collagen osteogenin and bone sialoprotein
2 The second approach uses biomolecules with osteotropic
effects which range from mitogenicity (interleukin growth
factor-I FGF-2 platelet derived growth factor ndashBB) to the
increasing activity of the bone cells which enhances the
collagen synthesis for osteoinduction
Zirconia implants
Zirconia (Zr02) is a ceramic material used in implantology because
Biocompatibility(bio inert)
Esthetics (because its colour is similar to the teeth) and
Mechanical properties which are better than alumina
High resistance to corrosion flexion and fracture
Contact with bone and soft tissue similar to that observed in
titanium implants
It can be used to produce a entire implant or as a coating
Advantages of Zirconia Dental Implants
No dark colour of the metal showing through the gums
No corrosion of the zirconia as with titanium
No piezo-electric currents between dissimilar metal in
the mouth
It is thermally non-conductive
Greater BIC (Bone ndash Implant Contact)
20 more bone apposition than titanium implants
Zeynep Ouml zkurt Zirconia Dental Implants A Literature Review Journal of Oral Implantology Vol 37(3)2011
RTQ (removal torque testing) Gahlert et al evaluated the RTQ values of
machined zirconia implants sandblasted zirconia implants and SLA titanium
implants The mean RTQ for machined zirconia implants was 259 Ncm the
mean RTQ for zirconia rough implants was 405 Ncm and the mean RTQ for
SLA titanium implants was 1052 Ncm
Fracture strength within clinically acceptable limits
Stress analysis Kohal et al observed the stress distribution patterns of
zirconia implants (ReImplant) which were found to have low well distributed
and similar stress distribution compared with titanium implants
PEEK implants (poly etheretherketone)
These implants are available in three fundamentally different
designs
TAU Diameter -48 mm lengths 10 125 15 mm
immediate loading possible
Low density bone
THETA Similar to TAU but D1 bone
IOTA It is a 3mm diameter implant (10 and 12 mm)
used in narrow ridges
Advantages
Good strengthfracture resistance and bioinertness
Promotes human oseteoblast cell growth
Disadvantages
Faintly radiopaque ndashdifficult for post-op evaluation
Lengths and diameters range is restricted
Advances in
commercially
available implant
systems
LASER- LOK TECHNOLOGY
Unique surface characteristics
Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using
laser ablation technology
Extremely consistent microchannels that are optimally
sized to attach and organize both osteoblasts and
fibroblasts
Includes a repeating nanostructure that maximizes
surface area and enables cell pseudopodia and collagen
microfibrils to interdigitate with the Laser-Lok surface
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
The advantages of CT based systems are
Uniform magnification
High contrast image with well-defined image layer free of
blurring
Easier identification of bone grafts or hydroxyappatite materials
used to augment maxillary bone in sinus region
Multiplanar views
Three-dimensional reconstruction
Simultaneous study of multiple implant sites
Availability of soft tissue for image analysis
Disadvantages
Limited availability of reconstructive software
Higher dose of radiation
Lack of understanding of dentists
Lack of usefulness for implant interface follow-up because of
metallic streak artifacts
Expense
Recent advances in Computed Tomography(CT)
Tuned Aperture CT (TACT)
Tuned aperture computed tomography (TACT) by Webber is a
relatively simple faster method for reconstructing tomographic
images
It is based on the concept of tomo-synthesis and optical-aperture
theory
TACT uses 2-D periapical radiographs acquired from different
projection angles as base images and permits retrospective
generation of longitudinal tomographic slices (TACT-S) lining up in
the Z axis of the area of interest
The overall radiation dose of TACT is not greater than 1 to 2 times
that of a conventional periapical X-ray film
The resolution is stated to be similar with 2-D radiographs
Artefacts associated with CT such as starburst patterns seen with
metallic restorations do not exist with TACT
The big conceptCone Bean Computed Tomography
Cone Beam Computed Tomography
Fan beam Cone beam
Software programs incorporating sophisticated
algorithms including back-filtered projection are applied
to these image data to generate a 3D volumetric data set
which can be used to provide primary reconstruction
images in 3 orthogonal planes (axial sagittal and coronal)
CBCT is devoted to maxillofacial area to scan and
visualize jaw bone lesions especially cancellous bone
It gives all the information of a CT but at 18th the
radiation dose and at a lower cost
CBCT is categorized into large medium and limited volume units based on the size
of their field of view (FOV)
Large (FOV)
bull 15-23 cm
bull Maxillofacial trauma
bull Orthodontic use
bull TMJ diseases
Medium FOV
bull 10-15 cm
bull Mandibulo-maxillary imaging
bull Pre-implant planning
bull Pathology
Small FOV
bull lt 10 cm
bull Endodontic applications
Advantages of CBCT
X-ray beam limitation
Image accuracy
Rapid scan time 10ndash70 seconds
Software can be made available to the user
Dose reduction Effective dose is 98 smaller than conventional CT
Reduced image artifact
Interactive computed tomography(ICT)
bullThis technique enables transfer of the imaging study to the
clinician as a computer filehellip
bullThe clinicianrsquos computer becomes a diagnostic radiologic
workstation with tools
bullAn important feature of ICT is that the clinician and radiologist can
perform ldquoelectronic surgeryrdquo (ES)
bull With an appropriately designed diagnostic
template ES can be performed to develop
the patientrsquos treatment plan electronically in
3 dimensions
bullTransfer of the plan to the patient at the
time of surgery can be accomplished by
production of the computer generated
three-dimensional stereotactic surgical
templates
Recent advances in
Computed Tomography(CT)
Microtomograph
Modification of CT it is specially useful in acquiring serial sections of bone
implant interface
Multi slice helical CT
The helical CT scan takes continuous pictures of the body in a rapid spiral motion
so that there are no gaps in the pictures collected
Recent Advances
in Implant Design
Mini implants
Mini dental implants (MDIs) are small diameter dental implants
Are sometimes referred to as SDIs (small diameter implants) as
well as NDIs (narrow body implants)
Diameter 18mm to 29mm (less than 3mm)
Various lengths 10 13 15 amp 18 mmrsquos
The MDI are available with either an O-ball head for use with
removable or fixed dentures or a square head for fixed prostheses or
retrofitting a poorly adapted partial denture
The body connects the tip with the prosthetic head and can be a
parallel sided cylinder or a progressively tapered cone
A small pilot bit is used to create the opening for the implant to be
threaded into the bone
The definitive implant supported crowns are usually delivered
within 2 weeks of surgery
Advantages
Immediate loading
Can be inserted in minimal tissues without relying on grafting
techniques
Minimally invasive procedure
One-stage denture stabilization
Does not require osteotomy
Cost-effective
Can be placed with a simple technique in patients with ridge too
narrow for conventional implants
Narrow-diameter implants Are they a predictable
treatment option A literature review
Joseacute-Luis Sierra-Saacutenchez Med Oral Patol Oral Cir Bucal 2014
Jan 119 (1)e74-81
The review included
Four randomized clinical trials
Ten prospective studies
Seven retrospective studies
The follow-up periods -12 months to 12 years
Total of 1607 patients
The patient age - 13 to 87 years
2980 implants
The recorded implant survival rates were above 90 in all the
studies Six studies published a survival rate of 100 at the end of
the follow-up period
The lowest survival rate (909) corresponded to the study
published by Barter et al
58 failures (implant loss) were recorded out of a total of 2980
implants
A larger number of failures were recorded with implants measuring
le 13 mm in length
Nineteen studies measured changes in peri-implant bone height
after implant loading 0065 mm the first year to 174 mm after a
follow-up period of 10 years
Araujo published a retrospective study on 33 mm implants placed
in posterior areas and rehabilitated following an immediate loading
protocol
Implant survival rate was 955 after 9 years of follow-up
That same year Degidi et al published a study comparing delayed
and immediate loading in narrow-diameter implants placed in both
anterior and posterior zones
Survival rate was 994 after a mean follow-up of 20 months
TRANSITIONAL IMPLANTS
Diameter ranges -18 to 28 mm
Length -7mm to 14mm
Fabricated with pure titanium in a single body with treated
surface
Primary function is to absorb masticatory stress during healing
phase
They should be placed at least 15 mm from adjacent teeth and
the distance between any transitional implant and a definitive
implant must be at least 15-2 mm
The abutment head generally has a 5 degree taper which makes it
optimal for retention of cement retained prostheses
Only one drill a 15 mm or 2 mm twist drill is required for
placement of the implants
Advantages
Provisionalisation of fully and partially edentulous jaws
Undisturbed healing of bone grafts
Effective way to generate aesthetic transitional appliances
Allows evaluation of phonetics and function
Cost effective
One ndash Piece Implants
The implant is machined from a piece of titanium that
incorporates both the implant body and an integral fixed abutment
in a single component
3 diameters -35 43 and 5 mm
4 lengths -10 13 15 and 16 mm
Clinical and radiographic evaluation of one-piece implants
used for immediate function
Jack a Hahn journal of oral implantology vol 33(3)2007
The aim of the present research was to evaluate the radiographic
outcome of a 1-piece implant when used for immediate function in
an ordinary patient pool
Forty-seven NobelDirect and NobelPerfect 1-piece implants
(Nobel Biocare Goumlteborg Sweden) were placed in maxillae and
mandibles
In this study 1 of the 47 implants had to be removed resulting in a
cumulative implant survival rate of 979 throughout the follow-up
period
The mean marginal bone level relative to the reference point after
1 year of loading (078 - 160 mm) as well as after 2 and 3 years of
loading was located above the first implant thread
In this study a bone level 2 mm apical to the reference point after
1 year of loading was observed at 2 implants (6)
The 1-piece implant design enables undisturbed healing
of the peri-implant soft tissue and avoids disruption of the
soft tissue seal when placing the definitive prosthetic
restoration
Annibali et al reported a series of patients treated
consecutively for first molar replacement according to
Immediate = group 1
Early = group 2
Late = Group 3
The implant survival rate
917 for early implants
950 for immediate post-extraction implants
100 for implants placed in healed sites
Short Dental Implants
A dental implant with length of 7 mm or less (Friberg et al 2000)
Any implant under 10 mm in length referred to as a lsquolsquoshortrsquorsquo
implant (Griffin TJ Cheung WS 2004)
A device with an intra-bony length of 8 mm or less (Renouard
and Nisand 2006)
Indication
Atropic Jaw
Proximity to vital structure
Single crowns
Overdentures
Advantages
1 Bone grafting for height often unnecessary
2 Less money pain and time prior to restoration of the implant
3 Simplified bone surgery
4 Implant insertion easier
Goodacre et al in 2003 reviewed
2754 implants - lt10 mm
3015 implants - gt10 mm in length
The failure rate of implants 10 mm or less was 10 compared
to a 3 failure rate of implants longer than 10 mm
Ivanoff et al in 1999 found an 8-mm-long 5-mm-diameter
implant failed 25 of the time in the maxilla and 33 of the
time in the mandible On the other hand the 10-mm and 12-
mm implants that were 5 mm in diameter reported no
mandibular failure and a 10 failure in the maxilla
Misch CE Short Dental Implants A Literature Review and Rationale for Use Dent Today 2005 Aug24(8)64-6 68
On the other hand a retrospective report by Misch et al was compiled
from 2 private offices using a square thread implant body design
(BioHorizons) rather than a v-shaped thread as primarily reported in the
previous literature
During a 3-year period 126 patients received implants less than 10 mm
long
Of the 437 implants there were 3 implant failures in the posterior
mandible and 1 failure in the posterior maxilla (99 survival)
All these failures were implants 9 mm long and 4 mm in diameter
Advances in Implant materials
Previously implants had macro-irregularities like macroscopic
threads fenestrations pores grooves steps threads or other
surface irregularities that were visible
However difficulty in achieving initial stability post implantation
relative motion adverse interfacial bone remodelling all lead to
search for improvement of the surface quality of a titanium dental
implant
BLASTING
Blasting -aluminium oxide titanium oxide and calcium phosphate
with particle size ranging from small medium to large (150- 350
microm)
Blasting a smooth Ti surface with Al2 O3 particles of 25 microm 75 microm
or 250 microm produces surfaces with roughness values of 116 to 120
143 and 194 to 220 respectively
A series of investigations have demonstrated a firmer bone
fixation of the implant with an average surface roughness (sa) of 1-
15microm than those of smoother implants with an average surface
roughness of 06microm
Blasting and Acid Etching
Acid etching can be done by using an HCL H2 SO4 mixture or by
pickling in 2 HF10HNO3 These processes leave pits and craters
Alumina or TiO2 for blasting the surface
Small - 25μm
large grit -025-05mm
medium grit - 250-500μm
Sand blasted and acid etched surfaces have a hydrophobic surface
The etching leads to the formation of Titanium hydrides and the
replacement of hydride by oxygen results in the slow transformation of
the implant surface resulting in nanometre sized particles of titanium on
the surface which helps in protein adhesion on implant surface
Dual acid etching with HCl and H2SO4 heated above 100ᴼC has
produced surface topography able to attach to fibrin scaffold and
promote adhesion of osteogenic cells
Sand blasting and etching can increase the rate and amount of the
bone formation
Flouride Surface Treatments
This treatment enhances osseointegration and osteoblastic
differentitation with increased expression of Cbfa1 osterix and
bone sialoprotein
Fluoridated rough implants also withstood greater push-out
forces and showed a significantly higher removal torque than
control implants
However detrimental effect of F on the corrosion resistance of
titanium and titanium alloys has been extensively reported
Anodized Surface Implants
Anodized surface implants are implants which are placed as anodes
in galvanic cells with phosphoric acid as the electrolyte and current is
passed through them ndash also ca ldquoTiunite surfacerdquo
The surface oxides grow from the native state of 5nm to
approximately 10000nm
The sa of TiUnite is reported to be 11microm and its sdr 37
Anodic oxidation results in the growth of a native titanium oxide
layer and a porous topography with the bone formation occurring
directly on the moderately rough oxidized surface
Clinical and Radiographic Evaluation of Braringnemark Implants with an
Anodized Surface following Seven-to-Eight Years of Functional Loading
David Gelb Bradley McaAllister et al Int J Dent 2013 2013 583567
The aim of this study was to evaluate the clinical and
radiographic long-term outcomes of dental implants with an
anodized TiUnite surface placed in routine clinical practice
38 single prosthesis
22 FPDs
80 implants in maxilla
27 in mandible
Mean marginal bone level change-149 plusmn 103 mm
907 of cases- no visible plaque93 -visible plaque
No prosthetic complication
Calandriello evaluated immediately placed anodized
implants in 33 patients and found a mean marginal bone
loss of 117thinspmm after 5 years
Friberg and Jemt compared 280 TiUnite implants to 110
machined implants in 111 patients and found marginal
bone loss after 5 years to be 075 and 06thinspmm respectively
with no significant difference between the two types of
implants
Laser etching and Micro Arc Oxidation
After the implants are ultrasonically cleaned they are laser etched
by using an NdYAG laser at a power of 50kw frequency of 75khz
and 164A current
They are then processed in an electrolyte solution with 35
glyceroposphate disodium salt pentahydrate and 12 calcium
acetate monohydrate by microarc oxidation (voltage 350v
frequency 800hz) for 15 seconds
Microarc oxidation produces a titania film with a porous structure
and micropores of 1-5microm
The mechanism of osseointegration of the oxidized implants has
been shown to be mechanical interlocking and biochemical
bonding
Surface coating Ti Plasma Spray
Porous rough Ti surface have been fabricated by plasma
spraying a Ti powder form of molten droplets at high temperature
at temperature in order of 15000C at 600ms
The Ti plasma spray after solidification often provides 004 ndash 005
mm thickness
Ti A spray has been reported to increase the surface area of bone
to implant interface (as much as 600) and stimulate adhesion
osteogenesis
Advantages
Enhance attachment by increasing ionic interactions
Increased load bearing capability by 25-30
Increased tensile strength through ingrowth of bony tissues into 3D feature
Disadvantages
Cracking and scaling of coating because of stresses produced by elevated temprature processing
Risk of accumulation of abraded material in the interface zone during implantation of TPS
Hydroxyapatite coatings
Hydroxyapatite [Ca10(PO4)6OH]2 coating was brought to the
dental profession by DeGroot
HA forms a strong chemical bond with bone due to the presence
of free calcium and phosphate compounds at the implant surface
The HA coating consists of amorphous and crystalline forms with
a large density of cracks
The top 1-2 microm of the HA layer being amorphous while the rest
of the crystalline layer is hexagonally packed
Indicated Fresh extraction sites
Newly grafted sites
Advantages
1 Protection of surrounding bone against metal ion release from the
substrate
2 Reported chemical bonding between HA and living bone-intimate
contact-biointegration
3 Partial dissolution of HA makes surrounding fluid rich in calcium
and phosphate ions which trigger cellular differentiation and bone
formation
Disadvantages
Induction of impurities due to thermal decomposition during
processing- affecting long term clinical fixation
Dissolution of HA at lower pH
HA coating on the implant surface (50-70microm) by various methods
1 Plasma spraying
2 The vacuum deposition technique(ion beam sputtering radiofrequency
sputtering)
3 The sol gel and dip coating method
4 Electrolytic process
Nanotitania coatings
Nanotitania coatings were prepared by using the sol-gel
technique
Nanotitania implants had an increased feature density and a large
feature coverage area as compared to the nano-HA implants
This could present more binding sites for the protein cell
attachment and for increased bone contact
he Nanotitania implants exhibited an ordered arrangement
forming a homogenous layer on underlying topography
Biologically active drugs incorporated dental
implants
Bisphosphonates Bisphosphate-loaded implant surfaces have
been reported to improve implant osseointegration
Simvastatin
Simvastatin could induce the expression of bone morphogenetic
protein (BMP) mRNA that might promote bone formation and
increase bone mineral density
Gentamycin along with the layer of HA can be coated onto the
implant surface which may act as a local prophylactic agent along
with the systemic antibiotics in dental implant surgery
Biochemical Methods
of the Surface
Modifications
Biochemical Methods of the Surface
Modifications
Their goal is to immobilize proteins enzymes or peptides on
biomaterials for the purpose of inducing specific cell and tissue
responses
1 One approach uses cell-adhesion molecules like fibronectin
vitronectin Type I collagen osteogenin and bone sialoprotein
2 The second approach uses biomolecules with osteotropic
effects which range from mitogenicity (interleukin growth
factor-I FGF-2 platelet derived growth factor ndashBB) to the
increasing activity of the bone cells which enhances the
collagen synthesis for osteoinduction
Zirconia implants
Zirconia (Zr02) is a ceramic material used in implantology because
Biocompatibility(bio inert)
Esthetics (because its colour is similar to the teeth) and
Mechanical properties which are better than alumina
High resistance to corrosion flexion and fracture
Contact with bone and soft tissue similar to that observed in
titanium implants
It can be used to produce a entire implant or as a coating
Advantages of Zirconia Dental Implants
No dark colour of the metal showing through the gums
No corrosion of the zirconia as with titanium
No piezo-electric currents between dissimilar metal in
the mouth
It is thermally non-conductive
Greater BIC (Bone ndash Implant Contact)
20 more bone apposition than titanium implants
Zeynep Ouml zkurt Zirconia Dental Implants A Literature Review Journal of Oral Implantology Vol 37(3)2011
RTQ (removal torque testing) Gahlert et al evaluated the RTQ values of
machined zirconia implants sandblasted zirconia implants and SLA titanium
implants The mean RTQ for machined zirconia implants was 259 Ncm the
mean RTQ for zirconia rough implants was 405 Ncm and the mean RTQ for
SLA titanium implants was 1052 Ncm
Fracture strength within clinically acceptable limits
Stress analysis Kohal et al observed the stress distribution patterns of
zirconia implants (ReImplant) which were found to have low well distributed
and similar stress distribution compared with titanium implants
PEEK implants (poly etheretherketone)
These implants are available in three fundamentally different
designs
TAU Diameter -48 mm lengths 10 125 15 mm
immediate loading possible
Low density bone
THETA Similar to TAU but D1 bone
IOTA It is a 3mm diameter implant (10 and 12 mm)
used in narrow ridges
Advantages
Good strengthfracture resistance and bioinertness
Promotes human oseteoblast cell growth
Disadvantages
Faintly radiopaque ndashdifficult for post-op evaluation
Lengths and diameters range is restricted
Advances in
commercially
available implant
systems
LASER- LOK TECHNOLOGY
Unique surface characteristics
Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using
laser ablation technology
Extremely consistent microchannels that are optimally
sized to attach and organize both osteoblasts and
fibroblasts
Includes a repeating nanostructure that maximizes
surface area and enables cell pseudopodia and collagen
microfibrils to interdigitate with the Laser-Lok surface
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Disadvantages
Limited availability of reconstructive software
Higher dose of radiation
Lack of understanding of dentists
Lack of usefulness for implant interface follow-up because of
metallic streak artifacts
Expense
Recent advances in Computed Tomography(CT)
Tuned Aperture CT (TACT)
Tuned aperture computed tomography (TACT) by Webber is a
relatively simple faster method for reconstructing tomographic
images
It is based on the concept of tomo-synthesis and optical-aperture
theory
TACT uses 2-D periapical radiographs acquired from different
projection angles as base images and permits retrospective
generation of longitudinal tomographic slices (TACT-S) lining up in
the Z axis of the area of interest
The overall radiation dose of TACT is not greater than 1 to 2 times
that of a conventional periapical X-ray film
The resolution is stated to be similar with 2-D radiographs
Artefacts associated with CT such as starburst patterns seen with
metallic restorations do not exist with TACT
The big conceptCone Bean Computed Tomography
Cone Beam Computed Tomography
Fan beam Cone beam
Software programs incorporating sophisticated
algorithms including back-filtered projection are applied
to these image data to generate a 3D volumetric data set
which can be used to provide primary reconstruction
images in 3 orthogonal planes (axial sagittal and coronal)
CBCT is devoted to maxillofacial area to scan and
visualize jaw bone lesions especially cancellous bone
It gives all the information of a CT but at 18th the
radiation dose and at a lower cost
CBCT is categorized into large medium and limited volume units based on the size
of their field of view (FOV)
Large (FOV)
bull 15-23 cm
bull Maxillofacial trauma
bull Orthodontic use
bull TMJ diseases
Medium FOV
bull 10-15 cm
bull Mandibulo-maxillary imaging
bull Pre-implant planning
bull Pathology
Small FOV
bull lt 10 cm
bull Endodontic applications
Advantages of CBCT
X-ray beam limitation
Image accuracy
Rapid scan time 10ndash70 seconds
Software can be made available to the user
Dose reduction Effective dose is 98 smaller than conventional CT
Reduced image artifact
Interactive computed tomography(ICT)
bullThis technique enables transfer of the imaging study to the
clinician as a computer filehellip
bullThe clinicianrsquos computer becomes a diagnostic radiologic
workstation with tools
bullAn important feature of ICT is that the clinician and radiologist can
perform ldquoelectronic surgeryrdquo (ES)
bull With an appropriately designed diagnostic
template ES can be performed to develop
the patientrsquos treatment plan electronically in
3 dimensions
bullTransfer of the plan to the patient at the
time of surgery can be accomplished by
production of the computer generated
three-dimensional stereotactic surgical
templates
Recent advances in
Computed Tomography(CT)
Microtomograph
Modification of CT it is specially useful in acquiring serial sections of bone
implant interface
Multi slice helical CT
The helical CT scan takes continuous pictures of the body in a rapid spiral motion
so that there are no gaps in the pictures collected
Recent Advances
in Implant Design
Mini implants
Mini dental implants (MDIs) are small diameter dental implants
Are sometimes referred to as SDIs (small diameter implants) as
well as NDIs (narrow body implants)
Diameter 18mm to 29mm (less than 3mm)
Various lengths 10 13 15 amp 18 mmrsquos
The MDI are available with either an O-ball head for use with
removable or fixed dentures or a square head for fixed prostheses or
retrofitting a poorly adapted partial denture
The body connects the tip with the prosthetic head and can be a
parallel sided cylinder or a progressively tapered cone
A small pilot bit is used to create the opening for the implant to be
threaded into the bone
The definitive implant supported crowns are usually delivered
within 2 weeks of surgery
Advantages
Immediate loading
Can be inserted in minimal tissues without relying on grafting
techniques
Minimally invasive procedure
One-stage denture stabilization
Does not require osteotomy
Cost-effective
Can be placed with a simple technique in patients with ridge too
narrow for conventional implants
Narrow-diameter implants Are they a predictable
treatment option A literature review
Joseacute-Luis Sierra-Saacutenchez Med Oral Patol Oral Cir Bucal 2014
Jan 119 (1)e74-81
The review included
Four randomized clinical trials
Ten prospective studies
Seven retrospective studies
The follow-up periods -12 months to 12 years
Total of 1607 patients
The patient age - 13 to 87 years
2980 implants
The recorded implant survival rates were above 90 in all the
studies Six studies published a survival rate of 100 at the end of
the follow-up period
The lowest survival rate (909) corresponded to the study
published by Barter et al
58 failures (implant loss) were recorded out of a total of 2980
implants
A larger number of failures were recorded with implants measuring
le 13 mm in length
Nineteen studies measured changes in peri-implant bone height
after implant loading 0065 mm the first year to 174 mm after a
follow-up period of 10 years
Araujo published a retrospective study on 33 mm implants placed
in posterior areas and rehabilitated following an immediate loading
protocol
Implant survival rate was 955 after 9 years of follow-up
That same year Degidi et al published a study comparing delayed
and immediate loading in narrow-diameter implants placed in both
anterior and posterior zones
Survival rate was 994 after a mean follow-up of 20 months
TRANSITIONAL IMPLANTS
Diameter ranges -18 to 28 mm
Length -7mm to 14mm
Fabricated with pure titanium in a single body with treated
surface
Primary function is to absorb masticatory stress during healing
phase
They should be placed at least 15 mm from adjacent teeth and
the distance between any transitional implant and a definitive
implant must be at least 15-2 mm
The abutment head generally has a 5 degree taper which makes it
optimal for retention of cement retained prostheses
Only one drill a 15 mm or 2 mm twist drill is required for
placement of the implants
Advantages
Provisionalisation of fully and partially edentulous jaws
Undisturbed healing of bone grafts
Effective way to generate aesthetic transitional appliances
Allows evaluation of phonetics and function
Cost effective
One ndash Piece Implants
The implant is machined from a piece of titanium that
incorporates both the implant body and an integral fixed abutment
in a single component
3 diameters -35 43 and 5 mm
4 lengths -10 13 15 and 16 mm
Clinical and radiographic evaluation of one-piece implants
used for immediate function
Jack a Hahn journal of oral implantology vol 33(3)2007
The aim of the present research was to evaluate the radiographic
outcome of a 1-piece implant when used for immediate function in
an ordinary patient pool
Forty-seven NobelDirect and NobelPerfect 1-piece implants
(Nobel Biocare Goumlteborg Sweden) were placed in maxillae and
mandibles
In this study 1 of the 47 implants had to be removed resulting in a
cumulative implant survival rate of 979 throughout the follow-up
period
The mean marginal bone level relative to the reference point after
1 year of loading (078 - 160 mm) as well as after 2 and 3 years of
loading was located above the first implant thread
In this study a bone level 2 mm apical to the reference point after
1 year of loading was observed at 2 implants (6)
The 1-piece implant design enables undisturbed healing
of the peri-implant soft tissue and avoids disruption of the
soft tissue seal when placing the definitive prosthetic
restoration
Annibali et al reported a series of patients treated
consecutively for first molar replacement according to
Immediate = group 1
Early = group 2
Late = Group 3
The implant survival rate
917 for early implants
950 for immediate post-extraction implants
100 for implants placed in healed sites
Short Dental Implants
A dental implant with length of 7 mm or less (Friberg et al 2000)
Any implant under 10 mm in length referred to as a lsquolsquoshortrsquorsquo
implant (Griffin TJ Cheung WS 2004)
A device with an intra-bony length of 8 mm or less (Renouard
and Nisand 2006)
Indication
Atropic Jaw
Proximity to vital structure
Single crowns
Overdentures
Advantages
1 Bone grafting for height often unnecessary
2 Less money pain and time prior to restoration of the implant
3 Simplified bone surgery
4 Implant insertion easier
Goodacre et al in 2003 reviewed
2754 implants - lt10 mm
3015 implants - gt10 mm in length
The failure rate of implants 10 mm or less was 10 compared
to a 3 failure rate of implants longer than 10 mm
Ivanoff et al in 1999 found an 8-mm-long 5-mm-diameter
implant failed 25 of the time in the maxilla and 33 of the
time in the mandible On the other hand the 10-mm and 12-
mm implants that were 5 mm in diameter reported no
mandibular failure and a 10 failure in the maxilla
Misch CE Short Dental Implants A Literature Review and Rationale for Use Dent Today 2005 Aug24(8)64-6 68
On the other hand a retrospective report by Misch et al was compiled
from 2 private offices using a square thread implant body design
(BioHorizons) rather than a v-shaped thread as primarily reported in the
previous literature
During a 3-year period 126 patients received implants less than 10 mm
long
Of the 437 implants there were 3 implant failures in the posterior
mandible and 1 failure in the posterior maxilla (99 survival)
All these failures were implants 9 mm long and 4 mm in diameter
Advances in Implant materials
Previously implants had macro-irregularities like macroscopic
threads fenestrations pores grooves steps threads or other
surface irregularities that were visible
However difficulty in achieving initial stability post implantation
relative motion adverse interfacial bone remodelling all lead to
search for improvement of the surface quality of a titanium dental
implant
BLASTING
Blasting -aluminium oxide titanium oxide and calcium phosphate
with particle size ranging from small medium to large (150- 350
microm)
Blasting a smooth Ti surface with Al2 O3 particles of 25 microm 75 microm
or 250 microm produces surfaces with roughness values of 116 to 120
143 and 194 to 220 respectively
A series of investigations have demonstrated a firmer bone
fixation of the implant with an average surface roughness (sa) of 1-
15microm than those of smoother implants with an average surface
roughness of 06microm
Blasting and Acid Etching
Acid etching can be done by using an HCL H2 SO4 mixture or by
pickling in 2 HF10HNO3 These processes leave pits and craters
Alumina or TiO2 for blasting the surface
Small - 25μm
large grit -025-05mm
medium grit - 250-500μm
Sand blasted and acid etched surfaces have a hydrophobic surface
The etching leads to the formation of Titanium hydrides and the
replacement of hydride by oxygen results in the slow transformation of
the implant surface resulting in nanometre sized particles of titanium on
the surface which helps in protein adhesion on implant surface
Dual acid etching with HCl and H2SO4 heated above 100ᴼC has
produced surface topography able to attach to fibrin scaffold and
promote adhesion of osteogenic cells
Sand blasting and etching can increase the rate and amount of the
bone formation
Flouride Surface Treatments
This treatment enhances osseointegration and osteoblastic
differentitation with increased expression of Cbfa1 osterix and
bone sialoprotein
Fluoridated rough implants also withstood greater push-out
forces and showed a significantly higher removal torque than
control implants
However detrimental effect of F on the corrosion resistance of
titanium and titanium alloys has been extensively reported
Anodized Surface Implants
Anodized surface implants are implants which are placed as anodes
in galvanic cells with phosphoric acid as the electrolyte and current is
passed through them ndash also ca ldquoTiunite surfacerdquo
The surface oxides grow from the native state of 5nm to
approximately 10000nm
The sa of TiUnite is reported to be 11microm and its sdr 37
Anodic oxidation results in the growth of a native titanium oxide
layer and a porous topography with the bone formation occurring
directly on the moderately rough oxidized surface
Clinical and Radiographic Evaluation of Braringnemark Implants with an
Anodized Surface following Seven-to-Eight Years of Functional Loading
David Gelb Bradley McaAllister et al Int J Dent 2013 2013 583567
The aim of this study was to evaluate the clinical and
radiographic long-term outcomes of dental implants with an
anodized TiUnite surface placed in routine clinical practice
38 single prosthesis
22 FPDs
80 implants in maxilla
27 in mandible
Mean marginal bone level change-149 plusmn 103 mm
907 of cases- no visible plaque93 -visible plaque
No prosthetic complication
Calandriello evaluated immediately placed anodized
implants in 33 patients and found a mean marginal bone
loss of 117thinspmm after 5 years
Friberg and Jemt compared 280 TiUnite implants to 110
machined implants in 111 patients and found marginal
bone loss after 5 years to be 075 and 06thinspmm respectively
with no significant difference between the two types of
implants
Laser etching and Micro Arc Oxidation
After the implants are ultrasonically cleaned they are laser etched
by using an NdYAG laser at a power of 50kw frequency of 75khz
and 164A current
They are then processed in an electrolyte solution with 35
glyceroposphate disodium salt pentahydrate and 12 calcium
acetate monohydrate by microarc oxidation (voltage 350v
frequency 800hz) for 15 seconds
Microarc oxidation produces a titania film with a porous structure
and micropores of 1-5microm
The mechanism of osseointegration of the oxidized implants has
been shown to be mechanical interlocking and biochemical
bonding
Surface coating Ti Plasma Spray
Porous rough Ti surface have been fabricated by plasma
spraying a Ti powder form of molten droplets at high temperature
at temperature in order of 15000C at 600ms
The Ti plasma spray after solidification often provides 004 ndash 005
mm thickness
Ti A spray has been reported to increase the surface area of bone
to implant interface (as much as 600) and stimulate adhesion
osteogenesis
Advantages
Enhance attachment by increasing ionic interactions
Increased load bearing capability by 25-30
Increased tensile strength through ingrowth of bony tissues into 3D feature
Disadvantages
Cracking and scaling of coating because of stresses produced by elevated temprature processing
Risk of accumulation of abraded material in the interface zone during implantation of TPS
Hydroxyapatite coatings
Hydroxyapatite [Ca10(PO4)6OH]2 coating was brought to the
dental profession by DeGroot
HA forms a strong chemical bond with bone due to the presence
of free calcium and phosphate compounds at the implant surface
The HA coating consists of amorphous and crystalline forms with
a large density of cracks
The top 1-2 microm of the HA layer being amorphous while the rest
of the crystalline layer is hexagonally packed
Indicated Fresh extraction sites
Newly grafted sites
Advantages
1 Protection of surrounding bone against metal ion release from the
substrate
2 Reported chemical bonding between HA and living bone-intimate
contact-biointegration
3 Partial dissolution of HA makes surrounding fluid rich in calcium
and phosphate ions which trigger cellular differentiation and bone
formation
Disadvantages
Induction of impurities due to thermal decomposition during
processing- affecting long term clinical fixation
Dissolution of HA at lower pH
HA coating on the implant surface (50-70microm) by various methods
1 Plasma spraying
2 The vacuum deposition technique(ion beam sputtering radiofrequency
sputtering)
3 The sol gel and dip coating method
4 Electrolytic process
Nanotitania coatings
Nanotitania coatings were prepared by using the sol-gel
technique
Nanotitania implants had an increased feature density and a large
feature coverage area as compared to the nano-HA implants
This could present more binding sites for the protein cell
attachment and for increased bone contact
he Nanotitania implants exhibited an ordered arrangement
forming a homogenous layer on underlying topography
Biologically active drugs incorporated dental
implants
Bisphosphonates Bisphosphate-loaded implant surfaces have
been reported to improve implant osseointegration
Simvastatin
Simvastatin could induce the expression of bone morphogenetic
protein (BMP) mRNA that might promote bone formation and
increase bone mineral density
Gentamycin along with the layer of HA can be coated onto the
implant surface which may act as a local prophylactic agent along
with the systemic antibiotics in dental implant surgery
Biochemical Methods
of the Surface
Modifications
Biochemical Methods of the Surface
Modifications
Their goal is to immobilize proteins enzymes or peptides on
biomaterials for the purpose of inducing specific cell and tissue
responses
1 One approach uses cell-adhesion molecules like fibronectin
vitronectin Type I collagen osteogenin and bone sialoprotein
2 The second approach uses biomolecules with osteotropic
effects which range from mitogenicity (interleukin growth
factor-I FGF-2 platelet derived growth factor ndashBB) to the
increasing activity of the bone cells which enhances the
collagen synthesis for osteoinduction
Zirconia implants
Zirconia (Zr02) is a ceramic material used in implantology because
Biocompatibility(bio inert)
Esthetics (because its colour is similar to the teeth) and
Mechanical properties which are better than alumina
High resistance to corrosion flexion and fracture
Contact with bone and soft tissue similar to that observed in
titanium implants
It can be used to produce a entire implant or as a coating
Advantages of Zirconia Dental Implants
No dark colour of the metal showing through the gums
No corrosion of the zirconia as with titanium
No piezo-electric currents between dissimilar metal in
the mouth
It is thermally non-conductive
Greater BIC (Bone ndash Implant Contact)
20 more bone apposition than titanium implants
Zeynep Ouml zkurt Zirconia Dental Implants A Literature Review Journal of Oral Implantology Vol 37(3)2011
RTQ (removal torque testing) Gahlert et al evaluated the RTQ values of
machined zirconia implants sandblasted zirconia implants and SLA titanium
implants The mean RTQ for machined zirconia implants was 259 Ncm the
mean RTQ for zirconia rough implants was 405 Ncm and the mean RTQ for
SLA titanium implants was 1052 Ncm
Fracture strength within clinically acceptable limits
Stress analysis Kohal et al observed the stress distribution patterns of
zirconia implants (ReImplant) which were found to have low well distributed
and similar stress distribution compared with titanium implants
PEEK implants (poly etheretherketone)
These implants are available in three fundamentally different
designs
TAU Diameter -48 mm lengths 10 125 15 mm
immediate loading possible
Low density bone
THETA Similar to TAU but D1 bone
IOTA It is a 3mm diameter implant (10 and 12 mm)
used in narrow ridges
Advantages
Good strengthfracture resistance and bioinertness
Promotes human oseteoblast cell growth
Disadvantages
Faintly radiopaque ndashdifficult for post-op evaluation
Lengths and diameters range is restricted
Advances in
commercially
available implant
systems
LASER- LOK TECHNOLOGY
Unique surface characteristics
Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using
laser ablation technology
Extremely consistent microchannels that are optimally
sized to attach and organize both osteoblasts and
fibroblasts
Includes a repeating nanostructure that maximizes
surface area and enables cell pseudopodia and collagen
microfibrils to interdigitate with the Laser-Lok surface
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Recent advances in Computed Tomography(CT)
Tuned Aperture CT (TACT)
Tuned aperture computed tomography (TACT) by Webber is a
relatively simple faster method for reconstructing tomographic
images
It is based on the concept of tomo-synthesis and optical-aperture
theory
TACT uses 2-D periapical radiographs acquired from different
projection angles as base images and permits retrospective
generation of longitudinal tomographic slices (TACT-S) lining up in
the Z axis of the area of interest
The overall radiation dose of TACT is not greater than 1 to 2 times
that of a conventional periapical X-ray film
The resolution is stated to be similar with 2-D radiographs
Artefacts associated with CT such as starburst patterns seen with
metallic restorations do not exist with TACT
The big conceptCone Bean Computed Tomography
Cone Beam Computed Tomography
Fan beam Cone beam
Software programs incorporating sophisticated
algorithms including back-filtered projection are applied
to these image data to generate a 3D volumetric data set
which can be used to provide primary reconstruction
images in 3 orthogonal planes (axial sagittal and coronal)
CBCT is devoted to maxillofacial area to scan and
visualize jaw bone lesions especially cancellous bone
It gives all the information of a CT but at 18th the
radiation dose and at a lower cost
CBCT is categorized into large medium and limited volume units based on the size
of their field of view (FOV)
Large (FOV)
bull 15-23 cm
bull Maxillofacial trauma
bull Orthodontic use
bull TMJ diseases
Medium FOV
bull 10-15 cm
bull Mandibulo-maxillary imaging
bull Pre-implant planning
bull Pathology
Small FOV
bull lt 10 cm
bull Endodontic applications
Advantages of CBCT
X-ray beam limitation
Image accuracy
Rapid scan time 10ndash70 seconds
Software can be made available to the user
Dose reduction Effective dose is 98 smaller than conventional CT
Reduced image artifact
Interactive computed tomography(ICT)
bullThis technique enables transfer of the imaging study to the
clinician as a computer filehellip
bullThe clinicianrsquos computer becomes a diagnostic radiologic
workstation with tools
bullAn important feature of ICT is that the clinician and radiologist can
perform ldquoelectronic surgeryrdquo (ES)
bull With an appropriately designed diagnostic
template ES can be performed to develop
the patientrsquos treatment plan electronically in
3 dimensions
bullTransfer of the plan to the patient at the
time of surgery can be accomplished by
production of the computer generated
three-dimensional stereotactic surgical
templates
Recent advances in
Computed Tomography(CT)
Microtomograph
Modification of CT it is specially useful in acquiring serial sections of bone
implant interface
Multi slice helical CT
The helical CT scan takes continuous pictures of the body in a rapid spiral motion
so that there are no gaps in the pictures collected
Recent Advances
in Implant Design
Mini implants
Mini dental implants (MDIs) are small diameter dental implants
Are sometimes referred to as SDIs (small diameter implants) as
well as NDIs (narrow body implants)
Diameter 18mm to 29mm (less than 3mm)
Various lengths 10 13 15 amp 18 mmrsquos
The MDI are available with either an O-ball head for use with
removable or fixed dentures or a square head for fixed prostheses or
retrofitting a poorly adapted partial denture
The body connects the tip with the prosthetic head and can be a
parallel sided cylinder or a progressively tapered cone
A small pilot bit is used to create the opening for the implant to be
threaded into the bone
The definitive implant supported crowns are usually delivered
within 2 weeks of surgery
Advantages
Immediate loading
Can be inserted in minimal tissues without relying on grafting
techniques
Minimally invasive procedure
One-stage denture stabilization
Does not require osteotomy
Cost-effective
Can be placed with a simple technique in patients with ridge too
narrow for conventional implants
Narrow-diameter implants Are they a predictable
treatment option A literature review
Joseacute-Luis Sierra-Saacutenchez Med Oral Patol Oral Cir Bucal 2014
Jan 119 (1)e74-81
The review included
Four randomized clinical trials
Ten prospective studies
Seven retrospective studies
The follow-up periods -12 months to 12 years
Total of 1607 patients
The patient age - 13 to 87 years
2980 implants
The recorded implant survival rates were above 90 in all the
studies Six studies published a survival rate of 100 at the end of
the follow-up period
The lowest survival rate (909) corresponded to the study
published by Barter et al
58 failures (implant loss) were recorded out of a total of 2980
implants
A larger number of failures were recorded with implants measuring
le 13 mm in length
Nineteen studies measured changes in peri-implant bone height
after implant loading 0065 mm the first year to 174 mm after a
follow-up period of 10 years
Araujo published a retrospective study on 33 mm implants placed
in posterior areas and rehabilitated following an immediate loading
protocol
Implant survival rate was 955 after 9 years of follow-up
That same year Degidi et al published a study comparing delayed
and immediate loading in narrow-diameter implants placed in both
anterior and posterior zones
Survival rate was 994 after a mean follow-up of 20 months
TRANSITIONAL IMPLANTS
Diameter ranges -18 to 28 mm
Length -7mm to 14mm
Fabricated with pure titanium in a single body with treated
surface
Primary function is to absorb masticatory stress during healing
phase
They should be placed at least 15 mm from adjacent teeth and
the distance between any transitional implant and a definitive
implant must be at least 15-2 mm
The abutment head generally has a 5 degree taper which makes it
optimal for retention of cement retained prostheses
Only one drill a 15 mm or 2 mm twist drill is required for
placement of the implants
Advantages
Provisionalisation of fully and partially edentulous jaws
Undisturbed healing of bone grafts
Effective way to generate aesthetic transitional appliances
Allows evaluation of phonetics and function
Cost effective
One ndash Piece Implants
The implant is machined from a piece of titanium that
incorporates both the implant body and an integral fixed abutment
in a single component
3 diameters -35 43 and 5 mm
4 lengths -10 13 15 and 16 mm
Clinical and radiographic evaluation of one-piece implants
used for immediate function
Jack a Hahn journal of oral implantology vol 33(3)2007
The aim of the present research was to evaluate the radiographic
outcome of a 1-piece implant when used for immediate function in
an ordinary patient pool
Forty-seven NobelDirect and NobelPerfect 1-piece implants
(Nobel Biocare Goumlteborg Sweden) were placed in maxillae and
mandibles
In this study 1 of the 47 implants had to be removed resulting in a
cumulative implant survival rate of 979 throughout the follow-up
period
The mean marginal bone level relative to the reference point after
1 year of loading (078 - 160 mm) as well as after 2 and 3 years of
loading was located above the first implant thread
In this study a bone level 2 mm apical to the reference point after
1 year of loading was observed at 2 implants (6)
The 1-piece implant design enables undisturbed healing
of the peri-implant soft tissue and avoids disruption of the
soft tissue seal when placing the definitive prosthetic
restoration
Annibali et al reported a series of patients treated
consecutively for first molar replacement according to
Immediate = group 1
Early = group 2
Late = Group 3
The implant survival rate
917 for early implants
950 for immediate post-extraction implants
100 for implants placed in healed sites
Short Dental Implants
A dental implant with length of 7 mm or less (Friberg et al 2000)
Any implant under 10 mm in length referred to as a lsquolsquoshortrsquorsquo
implant (Griffin TJ Cheung WS 2004)
A device with an intra-bony length of 8 mm or less (Renouard
and Nisand 2006)
Indication
Atropic Jaw
Proximity to vital structure
Single crowns
Overdentures
Advantages
1 Bone grafting for height often unnecessary
2 Less money pain and time prior to restoration of the implant
3 Simplified bone surgery
4 Implant insertion easier
Goodacre et al in 2003 reviewed
2754 implants - lt10 mm
3015 implants - gt10 mm in length
The failure rate of implants 10 mm or less was 10 compared
to a 3 failure rate of implants longer than 10 mm
Ivanoff et al in 1999 found an 8-mm-long 5-mm-diameter
implant failed 25 of the time in the maxilla and 33 of the
time in the mandible On the other hand the 10-mm and 12-
mm implants that were 5 mm in diameter reported no
mandibular failure and a 10 failure in the maxilla
Misch CE Short Dental Implants A Literature Review and Rationale for Use Dent Today 2005 Aug24(8)64-6 68
On the other hand a retrospective report by Misch et al was compiled
from 2 private offices using a square thread implant body design
(BioHorizons) rather than a v-shaped thread as primarily reported in the
previous literature
During a 3-year period 126 patients received implants less than 10 mm
long
Of the 437 implants there were 3 implant failures in the posterior
mandible and 1 failure in the posterior maxilla (99 survival)
All these failures were implants 9 mm long and 4 mm in diameter
Advances in Implant materials
Previously implants had macro-irregularities like macroscopic
threads fenestrations pores grooves steps threads or other
surface irregularities that were visible
However difficulty in achieving initial stability post implantation
relative motion adverse interfacial bone remodelling all lead to
search for improvement of the surface quality of a titanium dental
implant
BLASTING
Blasting -aluminium oxide titanium oxide and calcium phosphate
with particle size ranging from small medium to large (150- 350
microm)
Blasting a smooth Ti surface with Al2 O3 particles of 25 microm 75 microm
or 250 microm produces surfaces with roughness values of 116 to 120
143 and 194 to 220 respectively
A series of investigations have demonstrated a firmer bone
fixation of the implant with an average surface roughness (sa) of 1-
15microm than those of smoother implants with an average surface
roughness of 06microm
Blasting and Acid Etching
Acid etching can be done by using an HCL H2 SO4 mixture or by
pickling in 2 HF10HNO3 These processes leave pits and craters
Alumina or TiO2 for blasting the surface
Small - 25μm
large grit -025-05mm
medium grit - 250-500μm
Sand blasted and acid etched surfaces have a hydrophobic surface
The etching leads to the formation of Titanium hydrides and the
replacement of hydride by oxygen results in the slow transformation of
the implant surface resulting in nanometre sized particles of titanium on
the surface which helps in protein adhesion on implant surface
Dual acid etching with HCl and H2SO4 heated above 100ᴼC has
produced surface topography able to attach to fibrin scaffold and
promote adhesion of osteogenic cells
Sand blasting and etching can increase the rate and amount of the
bone formation
Flouride Surface Treatments
This treatment enhances osseointegration and osteoblastic
differentitation with increased expression of Cbfa1 osterix and
bone sialoprotein
Fluoridated rough implants also withstood greater push-out
forces and showed a significantly higher removal torque than
control implants
However detrimental effect of F on the corrosion resistance of
titanium and titanium alloys has been extensively reported
Anodized Surface Implants
Anodized surface implants are implants which are placed as anodes
in galvanic cells with phosphoric acid as the electrolyte and current is
passed through them ndash also ca ldquoTiunite surfacerdquo
The surface oxides grow from the native state of 5nm to
approximately 10000nm
The sa of TiUnite is reported to be 11microm and its sdr 37
Anodic oxidation results in the growth of a native titanium oxide
layer and a porous topography with the bone formation occurring
directly on the moderately rough oxidized surface
Clinical and Radiographic Evaluation of Braringnemark Implants with an
Anodized Surface following Seven-to-Eight Years of Functional Loading
David Gelb Bradley McaAllister et al Int J Dent 2013 2013 583567
The aim of this study was to evaluate the clinical and
radiographic long-term outcomes of dental implants with an
anodized TiUnite surface placed in routine clinical practice
38 single prosthesis
22 FPDs
80 implants in maxilla
27 in mandible
Mean marginal bone level change-149 plusmn 103 mm
907 of cases- no visible plaque93 -visible plaque
No prosthetic complication
Calandriello evaluated immediately placed anodized
implants in 33 patients and found a mean marginal bone
loss of 117thinspmm after 5 years
Friberg and Jemt compared 280 TiUnite implants to 110
machined implants in 111 patients and found marginal
bone loss after 5 years to be 075 and 06thinspmm respectively
with no significant difference between the two types of
implants
Laser etching and Micro Arc Oxidation
After the implants are ultrasonically cleaned they are laser etched
by using an NdYAG laser at a power of 50kw frequency of 75khz
and 164A current
They are then processed in an electrolyte solution with 35
glyceroposphate disodium salt pentahydrate and 12 calcium
acetate monohydrate by microarc oxidation (voltage 350v
frequency 800hz) for 15 seconds
Microarc oxidation produces a titania film with a porous structure
and micropores of 1-5microm
The mechanism of osseointegration of the oxidized implants has
been shown to be mechanical interlocking and biochemical
bonding
Surface coating Ti Plasma Spray
Porous rough Ti surface have been fabricated by plasma
spraying a Ti powder form of molten droplets at high temperature
at temperature in order of 15000C at 600ms
The Ti plasma spray after solidification often provides 004 ndash 005
mm thickness
Ti A spray has been reported to increase the surface area of bone
to implant interface (as much as 600) and stimulate adhesion
osteogenesis
Advantages
Enhance attachment by increasing ionic interactions
Increased load bearing capability by 25-30
Increased tensile strength through ingrowth of bony tissues into 3D feature
Disadvantages
Cracking and scaling of coating because of stresses produced by elevated temprature processing
Risk of accumulation of abraded material in the interface zone during implantation of TPS
Hydroxyapatite coatings
Hydroxyapatite [Ca10(PO4)6OH]2 coating was brought to the
dental profession by DeGroot
HA forms a strong chemical bond with bone due to the presence
of free calcium and phosphate compounds at the implant surface
The HA coating consists of amorphous and crystalline forms with
a large density of cracks
The top 1-2 microm of the HA layer being amorphous while the rest
of the crystalline layer is hexagonally packed
Indicated Fresh extraction sites
Newly grafted sites
Advantages
1 Protection of surrounding bone against metal ion release from the
substrate
2 Reported chemical bonding between HA and living bone-intimate
contact-biointegration
3 Partial dissolution of HA makes surrounding fluid rich in calcium
and phosphate ions which trigger cellular differentiation and bone
formation
Disadvantages
Induction of impurities due to thermal decomposition during
processing- affecting long term clinical fixation
Dissolution of HA at lower pH
HA coating on the implant surface (50-70microm) by various methods
1 Plasma spraying
2 The vacuum deposition technique(ion beam sputtering radiofrequency
sputtering)
3 The sol gel and dip coating method
4 Electrolytic process
Nanotitania coatings
Nanotitania coatings were prepared by using the sol-gel
technique
Nanotitania implants had an increased feature density and a large
feature coverage area as compared to the nano-HA implants
This could present more binding sites for the protein cell
attachment and for increased bone contact
he Nanotitania implants exhibited an ordered arrangement
forming a homogenous layer on underlying topography
Biologically active drugs incorporated dental
implants
Bisphosphonates Bisphosphate-loaded implant surfaces have
been reported to improve implant osseointegration
Simvastatin
Simvastatin could induce the expression of bone morphogenetic
protein (BMP) mRNA that might promote bone formation and
increase bone mineral density
Gentamycin along with the layer of HA can be coated onto the
implant surface which may act as a local prophylactic agent along
with the systemic antibiotics in dental implant surgery
Biochemical Methods
of the Surface
Modifications
Biochemical Methods of the Surface
Modifications
Their goal is to immobilize proteins enzymes or peptides on
biomaterials for the purpose of inducing specific cell and tissue
responses
1 One approach uses cell-adhesion molecules like fibronectin
vitronectin Type I collagen osteogenin and bone sialoprotein
2 The second approach uses biomolecules with osteotropic
effects which range from mitogenicity (interleukin growth
factor-I FGF-2 platelet derived growth factor ndashBB) to the
increasing activity of the bone cells which enhances the
collagen synthesis for osteoinduction
Zirconia implants
Zirconia (Zr02) is a ceramic material used in implantology because
Biocompatibility(bio inert)
Esthetics (because its colour is similar to the teeth) and
Mechanical properties which are better than alumina
High resistance to corrosion flexion and fracture
Contact with bone and soft tissue similar to that observed in
titanium implants
It can be used to produce a entire implant or as a coating
Advantages of Zirconia Dental Implants
No dark colour of the metal showing through the gums
No corrosion of the zirconia as with titanium
No piezo-electric currents between dissimilar metal in
the mouth
It is thermally non-conductive
Greater BIC (Bone ndash Implant Contact)
20 more bone apposition than titanium implants
Zeynep Ouml zkurt Zirconia Dental Implants A Literature Review Journal of Oral Implantology Vol 37(3)2011
RTQ (removal torque testing) Gahlert et al evaluated the RTQ values of
machined zirconia implants sandblasted zirconia implants and SLA titanium
implants The mean RTQ for machined zirconia implants was 259 Ncm the
mean RTQ for zirconia rough implants was 405 Ncm and the mean RTQ for
SLA titanium implants was 1052 Ncm
Fracture strength within clinically acceptable limits
Stress analysis Kohal et al observed the stress distribution patterns of
zirconia implants (ReImplant) which were found to have low well distributed
and similar stress distribution compared with titanium implants
PEEK implants (poly etheretherketone)
These implants are available in three fundamentally different
designs
TAU Diameter -48 mm lengths 10 125 15 mm
immediate loading possible
Low density bone
THETA Similar to TAU but D1 bone
IOTA It is a 3mm diameter implant (10 and 12 mm)
used in narrow ridges
Advantages
Good strengthfracture resistance and bioinertness
Promotes human oseteoblast cell growth
Disadvantages
Faintly radiopaque ndashdifficult for post-op evaluation
Lengths and diameters range is restricted
Advances in
commercially
available implant
systems
LASER- LOK TECHNOLOGY
Unique surface characteristics
Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using
laser ablation technology
Extremely consistent microchannels that are optimally
sized to attach and organize both osteoblasts and
fibroblasts
Includes a repeating nanostructure that maximizes
surface area and enables cell pseudopodia and collagen
microfibrils to interdigitate with the Laser-Lok surface
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
The overall radiation dose of TACT is not greater than 1 to 2 times
that of a conventional periapical X-ray film
The resolution is stated to be similar with 2-D radiographs
Artefacts associated with CT such as starburst patterns seen with
metallic restorations do not exist with TACT
The big conceptCone Bean Computed Tomography
Cone Beam Computed Tomography
Fan beam Cone beam
Software programs incorporating sophisticated
algorithms including back-filtered projection are applied
to these image data to generate a 3D volumetric data set
which can be used to provide primary reconstruction
images in 3 orthogonal planes (axial sagittal and coronal)
CBCT is devoted to maxillofacial area to scan and
visualize jaw bone lesions especially cancellous bone
It gives all the information of a CT but at 18th the
radiation dose and at a lower cost
CBCT is categorized into large medium and limited volume units based on the size
of their field of view (FOV)
Large (FOV)
bull 15-23 cm
bull Maxillofacial trauma
bull Orthodontic use
bull TMJ diseases
Medium FOV
bull 10-15 cm
bull Mandibulo-maxillary imaging
bull Pre-implant planning
bull Pathology
Small FOV
bull lt 10 cm
bull Endodontic applications
Advantages of CBCT
X-ray beam limitation
Image accuracy
Rapid scan time 10ndash70 seconds
Software can be made available to the user
Dose reduction Effective dose is 98 smaller than conventional CT
Reduced image artifact
Interactive computed tomography(ICT)
bullThis technique enables transfer of the imaging study to the
clinician as a computer filehellip
bullThe clinicianrsquos computer becomes a diagnostic radiologic
workstation with tools
bullAn important feature of ICT is that the clinician and radiologist can
perform ldquoelectronic surgeryrdquo (ES)
bull With an appropriately designed diagnostic
template ES can be performed to develop
the patientrsquos treatment plan electronically in
3 dimensions
bullTransfer of the plan to the patient at the
time of surgery can be accomplished by
production of the computer generated
three-dimensional stereotactic surgical
templates
Recent advances in
Computed Tomography(CT)
Microtomograph
Modification of CT it is specially useful in acquiring serial sections of bone
implant interface
Multi slice helical CT
The helical CT scan takes continuous pictures of the body in a rapid spiral motion
so that there are no gaps in the pictures collected
Recent Advances
in Implant Design
Mini implants
Mini dental implants (MDIs) are small diameter dental implants
Are sometimes referred to as SDIs (small diameter implants) as
well as NDIs (narrow body implants)
Diameter 18mm to 29mm (less than 3mm)
Various lengths 10 13 15 amp 18 mmrsquos
The MDI are available with either an O-ball head for use with
removable or fixed dentures or a square head for fixed prostheses or
retrofitting a poorly adapted partial denture
The body connects the tip with the prosthetic head and can be a
parallel sided cylinder or a progressively tapered cone
A small pilot bit is used to create the opening for the implant to be
threaded into the bone
The definitive implant supported crowns are usually delivered
within 2 weeks of surgery
Advantages
Immediate loading
Can be inserted in minimal tissues without relying on grafting
techniques
Minimally invasive procedure
One-stage denture stabilization
Does not require osteotomy
Cost-effective
Can be placed with a simple technique in patients with ridge too
narrow for conventional implants
Narrow-diameter implants Are they a predictable
treatment option A literature review
Joseacute-Luis Sierra-Saacutenchez Med Oral Patol Oral Cir Bucal 2014
Jan 119 (1)e74-81
The review included
Four randomized clinical trials
Ten prospective studies
Seven retrospective studies
The follow-up periods -12 months to 12 years
Total of 1607 patients
The patient age - 13 to 87 years
2980 implants
The recorded implant survival rates were above 90 in all the
studies Six studies published a survival rate of 100 at the end of
the follow-up period
The lowest survival rate (909) corresponded to the study
published by Barter et al
58 failures (implant loss) were recorded out of a total of 2980
implants
A larger number of failures were recorded with implants measuring
le 13 mm in length
Nineteen studies measured changes in peri-implant bone height
after implant loading 0065 mm the first year to 174 mm after a
follow-up period of 10 years
Araujo published a retrospective study on 33 mm implants placed
in posterior areas and rehabilitated following an immediate loading
protocol
Implant survival rate was 955 after 9 years of follow-up
That same year Degidi et al published a study comparing delayed
and immediate loading in narrow-diameter implants placed in both
anterior and posterior zones
Survival rate was 994 after a mean follow-up of 20 months
TRANSITIONAL IMPLANTS
Diameter ranges -18 to 28 mm
Length -7mm to 14mm
Fabricated with pure titanium in a single body with treated
surface
Primary function is to absorb masticatory stress during healing
phase
They should be placed at least 15 mm from adjacent teeth and
the distance between any transitional implant and a definitive
implant must be at least 15-2 mm
The abutment head generally has a 5 degree taper which makes it
optimal for retention of cement retained prostheses
Only one drill a 15 mm or 2 mm twist drill is required for
placement of the implants
Advantages
Provisionalisation of fully and partially edentulous jaws
Undisturbed healing of bone grafts
Effective way to generate aesthetic transitional appliances
Allows evaluation of phonetics and function
Cost effective
One ndash Piece Implants
The implant is machined from a piece of titanium that
incorporates both the implant body and an integral fixed abutment
in a single component
3 diameters -35 43 and 5 mm
4 lengths -10 13 15 and 16 mm
Clinical and radiographic evaluation of one-piece implants
used for immediate function
Jack a Hahn journal of oral implantology vol 33(3)2007
The aim of the present research was to evaluate the radiographic
outcome of a 1-piece implant when used for immediate function in
an ordinary patient pool
Forty-seven NobelDirect and NobelPerfect 1-piece implants
(Nobel Biocare Goumlteborg Sweden) were placed in maxillae and
mandibles
In this study 1 of the 47 implants had to be removed resulting in a
cumulative implant survival rate of 979 throughout the follow-up
period
The mean marginal bone level relative to the reference point after
1 year of loading (078 - 160 mm) as well as after 2 and 3 years of
loading was located above the first implant thread
In this study a bone level 2 mm apical to the reference point after
1 year of loading was observed at 2 implants (6)
The 1-piece implant design enables undisturbed healing
of the peri-implant soft tissue and avoids disruption of the
soft tissue seal when placing the definitive prosthetic
restoration
Annibali et al reported a series of patients treated
consecutively for first molar replacement according to
Immediate = group 1
Early = group 2
Late = Group 3
The implant survival rate
917 for early implants
950 for immediate post-extraction implants
100 for implants placed in healed sites
Short Dental Implants
A dental implant with length of 7 mm or less (Friberg et al 2000)
Any implant under 10 mm in length referred to as a lsquolsquoshortrsquorsquo
implant (Griffin TJ Cheung WS 2004)
A device with an intra-bony length of 8 mm or less (Renouard
and Nisand 2006)
Indication
Atropic Jaw
Proximity to vital structure
Single crowns
Overdentures
Advantages
1 Bone grafting for height often unnecessary
2 Less money pain and time prior to restoration of the implant
3 Simplified bone surgery
4 Implant insertion easier
Goodacre et al in 2003 reviewed
2754 implants - lt10 mm
3015 implants - gt10 mm in length
The failure rate of implants 10 mm or less was 10 compared
to a 3 failure rate of implants longer than 10 mm
Ivanoff et al in 1999 found an 8-mm-long 5-mm-diameter
implant failed 25 of the time in the maxilla and 33 of the
time in the mandible On the other hand the 10-mm and 12-
mm implants that were 5 mm in diameter reported no
mandibular failure and a 10 failure in the maxilla
Misch CE Short Dental Implants A Literature Review and Rationale for Use Dent Today 2005 Aug24(8)64-6 68
On the other hand a retrospective report by Misch et al was compiled
from 2 private offices using a square thread implant body design
(BioHorizons) rather than a v-shaped thread as primarily reported in the
previous literature
During a 3-year period 126 patients received implants less than 10 mm
long
Of the 437 implants there were 3 implant failures in the posterior
mandible and 1 failure in the posterior maxilla (99 survival)
All these failures were implants 9 mm long and 4 mm in diameter
Advances in Implant materials
Previously implants had macro-irregularities like macroscopic
threads fenestrations pores grooves steps threads or other
surface irregularities that were visible
However difficulty in achieving initial stability post implantation
relative motion adverse interfacial bone remodelling all lead to
search for improvement of the surface quality of a titanium dental
implant
BLASTING
Blasting -aluminium oxide titanium oxide and calcium phosphate
with particle size ranging from small medium to large (150- 350
microm)
Blasting a smooth Ti surface with Al2 O3 particles of 25 microm 75 microm
or 250 microm produces surfaces with roughness values of 116 to 120
143 and 194 to 220 respectively
A series of investigations have demonstrated a firmer bone
fixation of the implant with an average surface roughness (sa) of 1-
15microm than those of smoother implants with an average surface
roughness of 06microm
Blasting and Acid Etching
Acid etching can be done by using an HCL H2 SO4 mixture or by
pickling in 2 HF10HNO3 These processes leave pits and craters
Alumina or TiO2 for blasting the surface
Small - 25μm
large grit -025-05mm
medium grit - 250-500μm
Sand blasted and acid etched surfaces have a hydrophobic surface
The etching leads to the formation of Titanium hydrides and the
replacement of hydride by oxygen results in the slow transformation of
the implant surface resulting in nanometre sized particles of titanium on
the surface which helps in protein adhesion on implant surface
Dual acid etching with HCl and H2SO4 heated above 100ᴼC has
produced surface topography able to attach to fibrin scaffold and
promote adhesion of osteogenic cells
Sand blasting and etching can increase the rate and amount of the
bone formation
Flouride Surface Treatments
This treatment enhances osseointegration and osteoblastic
differentitation with increased expression of Cbfa1 osterix and
bone sialoprotein
Fluoridated rough implants also withstood greater push-out
forces and showed a significantly higher removal torque than
control implants
However detrimental effect of F on the corrosion resistance of
titanium and titanium alloys has been extensively reported
Anodized Surface Implants
Anodized surface implants are implants which are placed as anodes
in galvanic cells with phosphoric acid as the electrolyte and current is
passed through them ndash also ca ldquoTiunite surfacerdquo
The surface oxides grow from the native state of 5nm to
approximately 10000nm
The sa of TiUnite is reported to be 11microm and its sdr 37
Anodic oxidation results in the growth of a native titanium oxide
layer and a porous topography with the bone formation occurring
directly on the moderately rough oxidized surface
Clinical and Radiographic Evaluation of Braringnemark Implants with an
Anodized Surface following Seven-to-Eight Years of Functional Loading
David Gelb Bradley McaAllister et al Int J Dent 2013 2013 583567
The aim of this study was to evaluate the clinical and
radiographic long-term outcomes of dental implants with an
anodized TiUnite surface placed in routine clinical practice
38 single prosthesis
22 FPDs
80 implants in maxilla
27 in mandible
Mean marginal bone level change-149 plusmn 103 mm
907 of cases- no visible plaque93 -visible plaque
No prosthetic complication
Calandriello evaluated immediately placed anodized
implants in 33 patients and found a mean marginal bone
loss of 117thinspmm after 5 years
Friberg and Jemt compared 280 TiUnite implants to 110
machined implants in 111 patients and found marginal
bone loss after 5 years to be 075 and 06thinspmm respectively
with no significant difference between the two types of
implants
Laser etching and Micro Arc Oxidation
After the implants are ultrasonically cleaned they are laser etched
by using an NdYAG laser at a power of 50kw frequency of 75khz
and 164A current
They are then processed in an electrolyte solution with 35
glyceroposphate disodium salt pentahydrate and 12 calcium
acetate monohydrate by microarc oxidation (voltage 350v
frequency 800hz) for 15 seconds
Microarc oxidation produces a titania film with a porous structure
and micropores of 1-5microm
The mechanism of osseointegration of the oxidized implants has
been shown to be mechanical interlocking and biochemical
bonding
Surface coating Ti Plasma Spray
Porous rough Ti surface have been fabricated by plasma
spraying a Ti powder form of molten droplets at high temperature
at temperature in order of 15000C at 600ms
The Ti plasma spray after solidification often provides 004 ndash 005
mm thickness
Ti A spray has been reported to increase the surface area of bone
to implant interface (as much as 600) and stimulate adhesion
osteogenesis
Advantages
Enhance attachment by increasing ionic interactions
Increased load bearing capability by 25-30
Increased tensile strength through ingrowth of bony tissues into 3D feature
Disadvantages
Cracking and scaling of coating because of stresses produced by elevated temprature processing
Risk of accumulation of abraded material in the interface zone during implantation of TPS
Hydroxyapatite coatings
Hydroxyapatite [Ca10(PO4)6OH]2 coating was brought to the
dental profession by DeGroot
HA forms a strong chemical bond with bone due to the presence
of free calcium and phosphate compounds at the implant surface
The HA coating consists of amorphous and crystalline forms with
a large density of cracks
The top 1-2 microm of the HA layer being amorphous while the rest
of the crystalline layer is hexagonally packed
Indicated Fresh extraction sites
Newly grafted sites
Advantages
1 Protection of surrounding bone against metal ion release from the
substrate
2 Reported chemical bonding between HA and living bone-intimate
contact-biointegration
3 Partial dissolution of HA makes surrounding fluid rich in calcium
and phosphate ions which trigger cellular differentiation and bone
formation
Disadvantages
Induction of impurities due to thermal decomposition during
processing- affecting long term clinical fixation
Dissolution of HA at lower pH
HA coating on the implant surface (50-70microm) by various methods
1 Plasma spraying
2 The vacuum deposition technique(ion beam sputtering radiofrequency
sputtering)
3 The sol gel and dip coating method
4 Electrolytic process
Nanotitania coatings
Nanotitania coatings were prepared by using the sol-gel
technique
Nanotitania implants had an increased feature density and a large
feature coverage area as compared to the nano-HA implants
This could present more binding sites for the protein cell
attachment and for increased bone contact
he Nanotitania implants exhibited an ordered arrangement
forming a homogenous layer on underlying topography
Biologically active drugs incorporated dental
implants
Bisphosphonates Bisphosphate-loaded implant surfaces have
been reported to improve implant osseointegration
Simvastatin
Simvastatin could induce the expression of bone morphogenetic
protein (BMP) mRNA that might promote bone formation and
increase bone mineral density
Gentamycin along with the layer of HA can be coated onto the
implant surface which may act as a local prophylactic agent along
with the systemic antibiotics in dental implant surgery
Biochemical Methods
of the Surface
Modifications
Biochemical Methods of the Surface
Modifications
Their goal is to immobilize proteins enzymes or peptides on
biomaterials for the purpose of inducing specific cell and tissue
responses
1 One approach uses cell-adhesion molecules like fibronectin
vitronectin Type I collagen osteogenin and bone sialoprotein
2 The second approach uses biomolecules with osteotropic
effects which range from mitogenicity (interleukin growth
factor-I FGF-2 platelet derived growth factor ndashBB) to the
increasing activity of the bone cells which enhances the
collagen synthesis for osteoinduction
Zirconia implants
Zirconia (Zr02) is a ceramic material used in implantology because
Biocompatibility(bio inert)
Esthetics (because its colour is similar to the teeth) and
Mechanical properties which are better than alumina
High resistance to corrosion flexion and fracture
Contact with bone and soft tissue similar to that observed in
titanium implants
It can be used to produce a entire implant or as a coating
Advantages of Zirconia Dental Implants
No dark colour of the metal showing through the gums
No corrosion of the zirconia as with titanium
No piezo-electric currents between dissimilar metal in
the mouth
It is thermally non-conductive
Greater BIC (Bone ndash Implant Contact)
20 more bone apposition than titanium implants
Zeynep Ouml zkurt Zirconia Dental Implants A Literature Review Journal of Oral Implantology Vol 37(3)2011
RTQ (removal torque testing) Gahlert et al evaluated the RTQ values of
machined zirconia implants sandblasted zirconia implants and SLA titanium
implants The mean RTQ for machined zirconia implants was 259 Ncm the
mean RTQ for zirconia rough implants was 405 Ncm and the mean RTQ for
SLA titanium implants was 1052 Ncm
Fracture strength within clinically acceptable limits
Stress analysis Kohal et al observed the stress distribution patterns of
zirconia implants (ReImplant) which were found to have low well distributed
and similar stress distribution compared with titanium implants
PEEK implants (poly etheretherketone)
These implants are available in three fundamentally different
designs
TAU Diameter -48 mm lengths 10 125 15 mm
immediate loading possible
Low density bone
THETA Similar to TAU but D1 bone
IOTA It is a 3mm diameter implant (10 and 12 mm)
used in narrow ridges
Advantages
Good strengthfracture resistance and bioinertness
Promotes human oseteoblast cell growth
Disadvantages
Faintly radiopaque ndashdifficult for post-op evaluation
Lengths and diameters range is restricted
Advances in
commercially
available implant
systems
LASER- LOK TECHNOLOGY
Unique surface characteristics
Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using
laser ablation technology
Extremely consistent microchannels that are optimally
sized to attach and organize both osteoblasts and
fibroblasts
Includes a repeating nanostructure that maximizes
surface area and enables cell pseudopodia and collagen
microfibrils to interdigitate with the Laser-Lok surface
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
The big conceptCone Bean Computed Tomography
Cone Beam Computed Tomography
Fan beam Cone beam
Software programs incorporating sophisticated
algorithms including back-filtered projection are applied
to these image data to generate a 3D volumetric data set
which can be used to provide primary reconstruction
images in 3 orthogonal planes (axial sagittal and coronal)
CBCT is devoted to maxillofacial area to scan and
visualize jaw bone lesions especially cancellous bone
It gives all the information of a CT but at 18th the
radiation dose and at a lower cost
CBCT is categorized into large medium and limited volume units based on the size
of their field of view (FOV)
Large (FOV)
bull 15-23 cm
bull Maxillofacial trauma
bull Orthodontic use
bull TMJ diseases
Medium FOV
bull 10-15 cm
bull Mandibulo-maxillary imaging
bull Pre-implant planning
bull Pathology
Small FOV
bull lt 10 cm
bull Endodontic applications
Advantages of CBCT
X-ray beam limitation
Image accuracy
Rapid scan time 10ndash70 seconds
Software can be made available to the user
Dose reduction Effective dose is 98 smaller than conventional CT
Reduced image artifact
Interactive computed tomography(ICT)
bullThis technique enables transfer of the imaging study to the
clinician as a computer filehellip
bullThe clinicianrsquos computer becomes a diagnostic radiologic
workstation with tools
bullAn important feature of ICT is that the clinician and radiologist can
perform ldquoelectronic surgeryrdquo (ES)
bull With an appropriately designed diagnostic
template ES can be performed to develop
the patientrsquos treatment plan electronically in
3 dimensions
bullTransfer of the plan to the patient at the
time of surgery can be accomplished by
production of the computer generated
three-dimensional stereotactic surgical
templates
Recent advances in
Computed Tomography(CT)
Microtomograph
Modification of CT it is specially useful in acquiring serial sections of bone
implant interface
Multi slice helical CT
The helical CT scan takes continuous pictures of the body in a rapid spiral motion
so that there are no gaps in the pictures collected
Recent Advances
in Implant Design
Mini implants
Mini dental implants (MDIs) are small diameter dental implants
Are sometimes referred to as SDIs (small diameter implants) as
well as NDIs (narrow body implants)
Diameter 18mm to 29mm (less than 3mm)
Various lengths 10 13 15 amp 18 mmrsquos
The MDI are available with either an O-ball head for use with
removable or fixed dentures or a square head for fixed prostheses or
retrofitting a poorly adapted partial denture
The body connects the tip with the prosthetic head and can be a
parallel sided cylinder or a progressively tapered cone
A small pilot bit is used to create the opening for the implant to be
threaded into the bone
The definitive implant supported crowns are usually delivered
within 2 weeks of surgery
Advantages
Immediate loading
Can be inserted in minimal tissues without relying on grafting
techniques
Minimally invasive procedure
One-stage denture stabilization
Does not require osteotomy
Cost-effective
Can be placed with a simple technique in patients with ridge too
narrow for conventional implants
Narrow-diameter implants Are they a predictable
treatment option A literature review
Joseacute-Luis Sierra-Saacutenchez Med Oral Patol Oral Cir Bucal 2014
Jan 119 (1)e74-81
The review included
Four randomized clinical trials
Ten prospective studies
Seven retrospective studies
The follow-up periods -12 months to 12 years
Total of 1607 patients
The patient age - 13 to 87 years
2980 implants
The recorded implant survival rates were above 90 in all the
studies Six studies published a survival rate of 100 at the end of
the follow-up period
The lowest survival rate (909) corresponded to the study
published by Barter et al
58 failures (implant loss) were recorded out of a total of 2980
implants
A larger number of failures were recorded with implants measuring
le 13 mm in length
Nineteen studies measured changes in peri-implant bone height
after implant loading 0065 mm the first year to 174 mm after a
follow-up period of 10 years
Araujo published a retrospective study on 33 mm implants placed
in posterior areas and rehabilitated following an immediate loading
protocol
Implant survival rate was 955 after 9 years of follow-up
That same year Degidi et al published a study comparing delayed
and immediate loading in narrow-diameter implants placed in both
anterior and posterior zones
Survival rate was 994 after a mean follow-up of 20 months
TRANSITIONAL IMPLANTS
Diameter ranges -18 to 28 mm
Length -7mm to 14mm
Fabricated with pure titanium in a single body with treated
surface
Primary function is to absorb masticatory stress during healing
phase
They should be placed at least 15 mm from adjacent teeth and
the distance between any transitional implant and a definitive
implant must be at least 15-2 mm
The abutment head generally has a 5 degree taper which makes it
optimal for retention of cement retained prostheses
Only one drill a 15 mm or 2 mm twist drill is required for
placement of the implants
Advantages
Provisionalisation of fully and partially edentulous jaws
Undisturbed healing of bone grafts
Effective way to generate aesthetic transitional appliances
Allows evaluation of phonetics and function
Cost effective
One ndash Piece Implants
The implant is machined from a piece of titanium that
incorporates both the implant body and an integral fixed abutment
in a single component
3 diameters -35 43 and 5 mm
4 lengths -10 13 15 and 16 mm
Clinical and radiographic evaluation of one-piece implants
used for immediate function
Jack a Hahn journal of oral implantology vol 33(3)2007
The aim of the present research was to evaluate the radiographic
outcome of a 1-piece implant when used for immediate function in
an ordinary patient pool
Forty-seven NobelDirect and NobelPerfect 1-piece implants
(Nobel Biocare Goumlteborg Sweden) were placed in maxillae and
mandibles
In this study 1 of the 47 implants had to be removed resulting in a
cumulative implant survival rate of 979 throughout the follow-up
period
The mean marginal bone level relative to the reference point after
1 year of loading (078 - 160 mm) as well as after 2 and 3 years of
loading was located above the first implant thread
In this study a bone level 2 mm apical to the reference point after
1 year of loading was observed at 2 implants (6)
The 1-piece implant design enables undisturbed healing
of the peri-implant soft tissue and avoids disruption of the
soft tissue seal when placing the definitive prosthetic
restoration
Annibali et al reported a series of patients treated
consecutively for first molar replacement according to
Immediate = group 1
Early = group 2
Late = Group 3
The implant survival rate
917 for early implants
950 for immediate post-extraction implants
100 for implants placed in healed sites
Short Dental Implants
A dental implant with length of 7 mm or less (Friberg et al 2000)
Any implant under 10 mm in length referred to as a lsquolsquoshortrsquorsquo
implant (Griffin TJ Cheung WS 2004)
A device with an intra-bony length of 8 mm or less (Renouard
and Nisand 2006)
Indication
Atropic Jaw
Proximity to vital structure
Single crowns
Overdentures
Advantages
1 Bone grafting for height often unnecessary
2 Less money pain and time prior to restoration of the implant
3 Simplified bone surgery
4 Implant insertion easier
Goodacre et al in 2003 reviewed
2754 implants - lt10 mm
3015 implants - gt10 mm in length
The failure rate of implants 10 mm or less was 10 compared
to a 3 failure rate of implants longer than 10 mm
Ivanoff et al in 1999 found an 8-mm-long 5-mm-diameter
implant failed 25 of the time in the maxilla and 33 of the
time in the mandible On the other hand the 10-mm and 12-
mm implants that were 5 mm in diameter reported no
mandibular failure and a 10 failure in the maxilla
Misch CE Short Dental Implants A Literature Review and Rationale for Use Dent Today 2005 Aug24(8)64-6 68
On the other hand a retrospective report by Misch et al was compiled
from 2 private offices using a square thread implant body design
(BioHorizons) rather than a v-shaped thread as primarily reported in the
previous literature
During a 3-year period 126 patients received implants less than 10 mm
long
Of the 437 implants there were 3 implant failures in the posterior
mandible and 1 failure in the posterior maxilla (99 survival)
All these failures were implants 9 mm long and 4 mm in diameter
Advances in Implant materials
Previously implants had macro-irregularities like macroscopic
threads fenestrations pores grooves steps threads or other
surface irregularities that were visible
However difficulty in achieving initial stability post implantation
relative motion adverse interfacial bone remodelling all lead to
search for improvement of the surface quality of a titanium dental
implant
BLASTING
Blasting -aluminium oxide titanium oxide and calcium phosphate
with particle size ranging from small medium to large (150- 350
microm)
Blasting a smooth Ti surface with Al2 O3 particles of 25 microm 75 microm
or 250 microm produces surfaces with roughness values of 116 to 120
143 and 194 to 220 respectively
A series of investigations have demonstrated a firmer bone
fixation of the implant with an average surface roughness (sa) of 1-
15microm than those of smoother implants with an average surface
roughness of 06microm
Blasting and Acid Etching
Acid etching can be done by using an HCL H2 SO4 mixture or by
pickling in 2 HF10HNO3 These processes leave pits and craters
Alumina or TiO2 for blasting the surface
Small - 25μm
large grit -025-05mm
medium grit - 250-500μm
Sand blasted and acid etched surfaces have a hydrophobic surface
The etching leads to the formation of Titanium hydrides and the
replacement of hydride by oxygen results in the slow transformation of
the implant surface resulting in nanometre sized particles of titanium on
the surface which helps in protein adhesion on implant surface
Dual acid etching with HCl and H2SO4 heated above 100ᴼC has
produced surface topography able to attach to fibrin scaffold and
promote adhesion of osteogenic cells
Sand blasting and etching can increase the rate and amount of the
bone formation
Flouride Surface Treatments
This treatment enhances osseointegration and osteoblastic
differentitation with increased expression of Cbfa1 osterix and
bone sialoprotein
Fluoridated rough implants also withstood greater push-out
forces and showed a significantly higher removal torque than
control implants
However detrimental effect of F on the corrosion resistance of
titanium and titanium alloys has been extensively reported
Anodized Surface Implants
Anodized surface implants are implants which are placed as anodes
in galvanic cells with phosphoric acid as the electrolyte and current is
passed through them ndash also ca ldquoTiunite surfacerdquo
The surface oxides grow from the native state of 5nm to
approximately 10000nm
The sa of TiUnite is reported to be 11microm and its sdr 37
Anodic oxidation results in the growth of a native titanium oxide
layer and a porous topography with the bone formation occurring
directly on the moderately rough oxidized surface
Clinical and Radiographic Evaluation of Braringnemark Implants with an
Anodized Surface following Seven-to-Eight Years of Functional Loading
David Gelb Bradley McaAllister et al Int J Dent 2013 2013 583567
The aim of this study was to evaluate the clinical and
radiographic long-term outcomes of dental implants with an
anodized TiUnite surface placed in routine clinical practice
38 single prosthesis
22 FPDs
80 implants in maxilla
27 in mandible
Mean marginal bone level change-149 plusmn 103 mm
907 of cases- no visible plaque93 -visible plaque
No prosthetic complication
Calandriello evaluated immediately placed anodized
implants in 33 patients and found a mean marginal bone
loss of 117thinspmm after 5 years
Friberg and Jemt compared 280 TiUnite implants to 110
machined implants in 111 patients and found marginal
bone loss after 5 years to be 075 and 06thinspmm respectively
with no significant difference between the two types of
implants
Laser etching and Micro Arc Oxidation
After the implants are ultrasonically cleaned they are laser etched
by using an NdYAG laser at a power of 50kw frequency of 75khz
and 164A current
They are then processed in an electrolyte solution with 35
glyceroposphate disodium salt pentahydrate and 12 calcium
acetate monohydrate by microarc oxidation (voltage 350v
frequency 800hz) for 15 seconds
Microarc oxidation produces a titania film with a porous structure
and micropores of 1-5microm
The mechanism of osseointegration of the oxidized implants has
been shown to be mechanical interlocking and biochemical
bonding
Surface coating Ti Plasma Spray
Porous rough Ti surface have been fabricated by plasma
spraying a Ti powder form of molten droplets at high temperature
at temperature in order of 15000C at 600ms
The Ti plasma spray after solidification often provides 004 ndash 005
mm thickness
Ti A spray has been reported to increase the surface area of bone
to implant interface (as much as 600) and stimulate adhesion
osteogenesis
Advantages
Enhance attachment by increasing ionic interactions
Increased load bearing capability by 25-30
Increased tensile strength through ingrowth of bony tissues into 3D feature
Disadvantages
Cracking and scaling of coating because of stresses produced by elevated temprature processing
Risk of accumulation of abraded material in the interface zone during implantation of TPS
Hydroxyapatite coatings
Hydroxyapatite [Ca10(PO4)6OH]2 coating was brought to the
dental profession by DeGroot
HA forms a strong chemical bond with bone due to the presence
of free calcium and phosphate compounds at the implant surface
The HA coating consists of amorphous and crystalline forms with
a large density of cracks
The top 1-2 microm of the HA layer being amorphous while the rest
of the crystalline layer is hexagonally packed
Indicated Fresh extraction sites
Newly grafted sites
Advantages
1 Protection of surrounding bone against metal ion release from the
substrate
2 Reported chemical bonding between HA and living bone-intimate
contact-biointegration
3 Partial dissolution of HA makes surrounding fluid rich in calcium
and phosphate ions which trigger cellular differentiation and bone
formation
Disadvantages
Induction of impurities due to thermal decomposition during
processing- affecting long term clinical fixation
Dissolution of HA at lower pH
HA coating on the implant surface (50-70microm) by various methods
1 Plasma spraying
2 The vacuum deposition technique(ion beam sputtering radiofrequency
sputtering)
3 The sol gel and dip coating method
4 Electrolytic process
Nanotitania coatings
Nanotitania coatings were prepared by using the sol-gel
technique
Nanotitania implants had an increased feature density and a large
feature coverage area as compared to the nano-HA implants
This could present more binding sites for the protein cell
attachment and for increased bone contact
he Nanotitania implants exhibited an ordered arrangement
forming a homogenous layer on underlying topography
Biologically active drugs incorporated dental
implants
Bisphosphonates Bisphosphate-loaded implant surfaces have
been reported to improve implant osseointegration
Simvastatin
Simvastatin could induce the expression of bone morphogenetic
protein (BMP) mRNA that might promote bone formation and
increase bone mineral density
Gentamycin along with the layer of HA can be coated onto the
implant surface which may act as a local prophylactic agent along
with the systemic antibiotics in dental implant surgery
Biochemical Methods
of the Surface
Modifications
Biochemical Methods of the Surface
Modifications
Their goal is to immobilize proteins enzymes or peptides on
biomaterials for the purpose of inducing specific cell and tissue
responses
1 One approach uses cell-adhesion molecules like fibronectin
vitronectin Type I collagen osteogenin and bone sialoprotein
2 The second approach uses biomolecules with osteotropic
effects which range from mitogenicity (interleukin growth
factor-I FGF-2 platelet derived growth factor ndashBB) to the
increasing activity of the bone cells which enhances the
collagen synthesis for osteoinduction
Zirconia implants
Zirconia (Zr02) is a ceramic material used in implantology because
Biocompatibility(bio inert)
Esthetics (because its colour is similar to the teeth) and
Mechanical properties which are better than alumina
High resistance to corrosion flexion and fracture
Contact with bone and soft tissue similar to that observed in
titanium implants
It can be used to produce a entire implant or as a coating
Advantages of Zirconia Dental Implants
No dark colour of the metal showing through the gums
No corrosion of the zirconia as with titanium
No piezo-electric currents between dissimilar metal in
the mouth
It is thermally non-conductive
Greater BIC (Bone ndash Implant Contact)
20 more bone apposition than titanium implants
Zeynep Ouml zkurt Zirconia Dental Implants A Literature Review Journal of Oral Implantology Vol 37(3)2011
RTQ (removal torque testing) Gahlert et al evaluated the RTQ values of
machined zirconia implants sandblasted zirconia implants and SLA titanium
implants The mean RTQ for machined zirconia implants was 259 Ncm the
mean RTQ for zirconia rough implants was 405 Ncm and the mean RTQ for
SLA titanium implants was 1052 Ncm
Fracture strength within clinically acceptable limits
Stress analysis Kohal et al observed the stress distribution patterns of
zirconia implants (ReImplant) which were found to have low well distributed
and similar stress distribution compared with titanium implants
PEEK implants (poly etheretherketone)
These implants are available in three fundamentally different
designs
TAU Diameter -48 mm lengths 10 125 15 mm
immediate loading possible
Low density bone
THETA Similar to TAU but D1 bone
IOTA It is a 3mm diameter implant (10 and 12 mm)
used in narrow ridges
Advantages
Good strengthfracture resistance and bioinertness
Promotes human oseteoblast cell growth
Disadvantages
Faintly radiopaque ndashdifficult for post-op evaluation
Lengths and diameters range is restricted
Advances in
commercially
available implant
systems
LASER- LOK TECHNOLOGY
Unique surface characteristics
Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using
laser ablation technology
Extremely consistent microchannels that are optimally
sized to attach and organize both osteoblasts and
fibroblasts
Includes a repeating nanostructure that maximizes
surface area and enables cell pseudopodia and collagen
microfibrils to interdigitate with the Laser-Lok surface
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Cone Beam Computed Tomography
Fan beam Cone beam
Software programs incorporating sophisticated
algorithms including back-filtered projection are applied
to these image data to generate a 3D volumetric data set
which can be used to provide primary reconstruction
images in 3 orthogonal planes (axial sagittal and coronal)
CBCT is devoted to maxillofacial area to scan and
visualize jaw bone lesions especially cancellous bone
It gives all the information of a CT but at 18th the
radiation dose and at a lower cost
CBCT is categorized into large medium and limited volume units based on the size
of their field of view (FOV)
Large (FOV)
bull 15-23 cm
bull Maxillofacial trauma
bull Orthodontic use
bull TMJ diseases
Medium FOV
bull 10-15 cm
bull Mandibulo-maxillary imaging
bull Pre-implant planning
bull Pathology
Small FOV
bull lt 10 cm
bull Endodontic applications
Advantages of CBCT
X-ray beam limitation
Image accuracy
Rapid scan time 10ndash70 seconds
Software can be made available to the user
Dose reduction Effective dose is 98 smaller than conventional CT
Reduced image artifact
Interactive computed tomography(ICT)
bullThis technique enables transfer of the imaging study to the
clinician as a computer filehellip
bullThe clinicianrsquos computer becomes a diagnostic radiologic
workstation with tools
bullAn important feature of ICT is that the clinician and radiologist can
perform ldquoelectronic surgeryrdquo (ES)
bull With an appropriately designed diagnostic
template ES can be performed to develop
the patientrsquos treatment plan electronically in
3 dimensions
bullTransfer of the plan to the patient at the
time of surgery can be accomplished by
production of the computer generated
three-dimensional stereotactic surgical
templates
Recent advances in
Computed Tomography(CT)
Microtomograph
Modification of CT it is specially useful in acquiring serial sections of bone
implant interface
Multi slice helical CT
The helical CT scan takes continuous pictures of the body in a rapid spiral motion
so that there are no gaps in the pictures collected
Recent Advances
in Implant Design
Mini implants
Mini dental implants (MDIs) are small diameter dental implants
Are sometimes referred to as SDIs (small diameter implants) as
well as NDIs (narrow body implants)
Diameter 18mm to 29mm (less than 3mm)
Various lengths 10 13 15 amp 18 mmrsquos
The MDI are available with either an O-ball head for use with
removable or fixed dentures or a square head for fixed prostheses or
retrofitting a poorly adapted partial denture
The body connects the tip with the prosthetic head and can be a
parallel sided cylinder or a progressively tapered cone
A small pilot bit is used to create the opening for the implant to be
threaded into the bone
The definitive implant supported crowns are usually delivered
within 2 weeks of surgery
Advantages
Immediate loading
Can be inserted in minimal tissues without relying on grafting
techniques
Minimally invasive procedure
One-stage denture stabilization
Does not require osteotomy
Cost-effective
Can be placed with a simple technique in patients with ridge too
narrow for conventional implants
Narrow-diameter implants Are they a predictable
treatment option A literature review
Joseacute-Luis Sierra-Saacutenchez Med Oral Patol Oral Cir Bucal 2014
Jan 119 (1)e74-81
The review included
Four randomized clinical trials
Ten prospective studies
Seven retrospective studies
The follow-up periods -12 months to 12 years
Total of 1607 patients
The patient age - 13 to 87 years
2980 implants
The recorded implant survival rates were above 90 in all the
studies Six studies published a survival rate of 100 at the end of
the follow-up period
The lowest survival rate (909) corresponded to the study
published by Barter et al
58 failures (implant loss) were recorded out of a total of 2980
implants
A larger number of failures were recorded with implants measuring
le 13 mm in length
Nineteen studies measured changes in peri-implant bone height
after implant loading 0065 mm the first year to 174 mm after a
follow-up period of 10 years
Araujo published a retrospective study on 33 mm implants placed
in posterior areas and rehabilitated following an immediate loading
protocol
Implant survival rate was 955 after 9 years of follow-up
That same year Degidi et al published a study comparing delayed
and immediate loading in narrow-diameter implants placed in both
anterior and posterior zones
Survival rate was 994 after a mean follow-up of 20 months
TRANSITIONAL IMPLANTS
Diameter ranges -18 to 28 mm
Length -7mm to 14mm
Fabricated with pure titanium in a single body with treated
surface
Primary function is to absorb masticatory stress during healing
phase
They should be placed at least 15 mm from adjacent teeth and
the distance between any transitional implant and a definitive
implant must be at least 15-2 mm
The abutment head generally has a 5 degree taper which makes it
optimal for retention of cement retained prostheses
Only one drill a 15 mm or 2 mm twist drill is required for
placement of the implants
Advantages
Provisionalisation of fully and partially edentulous jaws
Undisturbed healing of bone grafts
Effective way to generate aesthetic transitional appliances
Allows evaluation of phonetics and function
Cost effective
One ndash Piece Implants
The implant is machined from a piece of titanium that
incorporates both the implant body and an integral fixed abutment
in a single component
3 diameters -35 43 and 5 mm
4 lengths -10 13 15 and 16 mm
Clinical and radiographic evaluation of one-piece implants
used for immediate function
Jack a Hahn journal of oral implantology vol 33(3)2007
The aim of the present research was to evaluate the radiographic
outcome of a 1-piece implant when used for immediate function in
an ordinary patient pool
Forty-seven NobelDirect and NobelPerfect 1-piece implants
(Nobel Biocare Goumlteborg Sweden) were placed in maxillae and
mandibles
In this study 1 of the 47 implants had to be removed resulting in a
cumulative implant survival rate of 979 throughout the follow-up
period
The mean marginal bone level relative to the reference point after
1 year of loading (078 - 160 mm) as well as after 2 and 3 years of
loading was located above the first implant thread
In this study a bone level 2 mm apical to the reference point after
1 year of loading was observed at 2 implants (6)
The 1-piece implant design enables undisturbed healing
of the peri-implant soft tissue and avoids disruption of the
soft tissue seal when placing the definitive prosthetic
restoration
Annibali et al reported a series of patients treated
consecutively for first molar replacement according to
Immediate = group 1
Early = group 2
Late = Group 3
The implant survival rate
917 for early implants
950 for immediate post-extraction implants
100 for implants placed in healed sites
Short Dental Implants
A dental implant with length of 7 mm or less (Friberg et al 2000)
Any implant under 10 mm in length referred to as a lsquolsquoshortrsquorsquo
implant (Griffin TJ Cheung WS 2004)
A device with an intra-bony length of 8 mm or less (Renouard
and Nisand 2006)
Indication
Atropic Jaw
Proximity to vital structure
Single crowns
Overdentures
Advantages
1 Bone grafting for height often unnecessary
2 Less money pain and time prior to restoration of the implant
3 Simplified bone surgery
4 Implant insertion easier
Goodacre et al in 2003 reviewed
2754 implants - lt10 mm
3015 implants - gt10 mm in length
The failure rate of implants 10 mm or less was 10 compared
to a 3 failure rate of implants longer than 10 mm
Ivanoff et al in 1999 found an 8-mm-long 5-mm-diameter
implant failed 25 of the time in the maxilla and 33 of the
time in the mandible On the other hand the 10-mm and 12-
mm implants that were 5 mm in diameter reported no
mandibular failure and a 10 failure in the maxilla
Misch CE Short Dental Implants A Literature Review and Rationale for Use Dent Today 2005 Aug24(8)64-6 68
On the other hand a retrospective report by Misch et al was compiled
from 2 private offices using a square thread implant body design
(BioHorizons) rather than a v-shaped thread as primarily reported in the
previous literature
During a 3-year period 126 patients received implants less than 10 mm
long
Of the 437 implants there were 3 implant failures in the posterior
mandible and 1 failure in the posterior maxilla (99 survival)
All these failures were implants 9 mm long and 4 mm in diameter
Advances in Implant materials
Previously implants had macro-irregularities like macroscopic
threads fenestrations pores grooves steps threads or other
surface irregularities that were visible
However difficulty in achieving initial stability post implantation
relative motion adverse interfacial bone remodelling all lead to
search for improvement of the surface quality of a titanium dental
implant
BLASTING
Blasting -aluminium oxide titanium oxide and calcium phosphate
with particle size ranging from small medium to large (150- 350
microm)
Blasting a smooth Ti surface with Al2 O3 particles of 25 microm 75 microm
or 250 microm produces surfaces with roughness values of 116 to 120
143 and 194 to 220 respectively
A series of investigations have demonstrated a firmer bone
fixation of the implant with an average surface roughness (sa) of 1-
15microm than those of smoother implants with an average surface
roughness of 06microm
Blasting and Acid Etching
Acid etching can be done by using an HCL H2 SO4 mixture or by
pickling in 2 HF10HNO3 These processes leave pits and craters
Alumina or TiO2 for blasting the surface
Small - 25μm
large grit -025-05mm
medium grit - 250-500μm
Sand blasted and acid etched surfaces have a hydrophobic surface
The etching leads to the formation of Titanium hydrides and the
replacement of hydride by oxygen results in the slow transformation of
the implant surface resulting in nanometre sized particles of titanium on
the surface which helps in protein adhesion on implant surface
Dual acid etching with HCl and H2SO4 heated above 100ᴼC has
produced surface topography able to attach to fibrin scaffold and
promote adhesion of osteogenic cells
Sand blasting and etching can increase the rate and amount of the
bone formation
Flouride Surface Treatments
This treatment enhances osseointegration and osteoblastic
differentitation with increased expression of Cbfa1 osterix and
bone sialoprotein
Fluoridated rough implants also withstood greater push-out
forces and showed a significantly higher removal torque than
control implants
However detrimental effect of F on the corrosion resistance of
titanium and titanium alloys has been extensively reported
Anodized Surface Implants
Anodized surface implants are implants which are placed as anodes
in galvanic cells with phosphoric acid as the electrolyte and current is
passed through them ndash also ca ldquoTiunite surfacerdquo
The surface oxides grow from the native state of 5nm to
approximately 10000nm
The sa of TiUnite is reported to be 11microm and its sdr 37
Anodic oxidation results in the growth of a native titanium oxide
layer and a porous topography with the bone formation occurring
directly on the moderately rough oxidized surface
Clinical and Radiographic Evaluation of Braringnemark Implants with an
Anodized Surface following Seven-to-Eight Years of Functional Loading
David Gelb Bradley McaAllister et al Int J Dent 2013 2013 583567
The aim of this study was to evaluate the clinical and
radiographic long-term outcomes of dental implants with an
anodized TiUnite surface placed in routine clinical practice
38 single prosthesis
22 FPDs
80 implants in maxilla
27 in mandible
Mean marginal bone level change-149 plusmn 103 mm
907 of cases- no visible plaque93 -visible plaque
No prosthetic complication
Calandriello evaluated immediately placed anodized
implants in 33 patients and found a mean marginal bone
loss of 117thinspmm after 5 years
Friberg and Jemt compared 280 TiUnite implants to 110
machined implants in 111 patients and found marginal
bone loss after 5 years to be 075 and 06thinspmm respectively
with no significant difference between the two types of
implants
Laser etching and Micro Arc Oxidation
After the implants are ultrasonically cleaned they are laser etched
by using an NdYAG laser at a power of 50kw frequency of 75khz
and 164A current
They are then processed in an electrolyte solution with 35
glyceroposphate disodium salt pentahydrate and 12 calcium
acetate monohydrate by microarc oxidation (voltage 350v
frequency 800hz) for 15 seconds
Microarc oxidation produces a titania film with a porous structure
and micropores of 1-5microm
The mechanism of osseointegration of the oxidized implants has
been shown to be mechanical interlocking and biochemical
bonding
Surface coating Ti Plasma Spray
Porous rough Ti surface have been fabricated by plasma
spraying a Ti powder form of molten droplets at high temperature
at temperature in order of 15000C at 600ms
The Ti plasma spray after solidification often provides 004 ndash 005
mm thickness
Ti A spray has been reported to increase the surface area of bone
to implant interface (as much as 600) and stimulate adhesion
osteogenesis
Advantages
Enhance attachment by increasing ionic interactions
Increased load bearing capability by 25-30
Increased tensile strength through ingrowth of bony tissues into 3D feature
Disadvantages
Cracking and scaling of coating because of stresses produced by elevated temprature processing
Risk of accumulation of abraded material in the interface zone during implantation of TPS
Hydroxyapatite coatings
Hydroxyapatite [Ca10(PO4)6OH]2 coating was brought to the
dental profession by DeGroot
HA forms a strong chemical bond with bone due to the presence
of free calcium and phosphate compounds at the implant surface
The HA coating consists of amorphous and crystalline forms with
a large density of cracks
The top 1-2 microm of the HA layer being amorphous while the rest
of the crystalline layer is hexagonally packed
Indicated Fresh extraction sites
Newly grafted sites
Advantages
1 Protection of surrounding bone against metal ion release from the
substrate
2 Reported chemical bonding between HA and living bone-intimate
contact-biointegration
3 Partial dissolution of HA makes surrounding fluid rich in calcium
and phosphate ions which trigger cellular differentiation and bone
formation
Disadvantages
Induction of impurities due to thermal decomposition during
processing- affecting long term clinical fixation
Dissolution of HA at lower pH
HA coating on the implant surface (50-70microm) by various methods
1 Plasma spraying
2 The vacuum deposition technique(ion beam sputtering radiofrequency
sputtering)
3 The sol gel and dip coating method
4 Electrolytic process
Nanotitania coatings
Nanotitania coatings were prepared by using the sol-gel
technique
Nanotitania implants had an increased feature density and a large
feature coverage area as compared to the nano-HA implants
This could present more binding sites for the protein cell
attachment and for increased bone contact
he Nanotitania implants exhibited an ordered arrangement
forming a homogenous layer on underlying topography
Biologically active drugs incorporated dental
implants
Bisphosphonates Bisphosphate-loaded implant surfaces have
been reported to improve implant osseointegration
Simvastatin
Simvastatin could induce the expression of bone morphogenetic
protein (BMP) mRNA that might promote bone formation and
increase bone mineral density
Gentamycin along with the layer of HA can be coated onto the
implant surface which may act as a local prophylactic agent along
with the systemic antibiotics in dental implant surgery
Biochemical Methods
of the Surface
Modifications
Biochemical Methods of the Surface
Modifications
Their goal is to immobilize proteins enzymes or peptides on
biomaterials for the purpose of inducing specific cell and tissue
responses
1 One approach uses cell-adhesion molecules like fibronectin
vitronectin Type I collagen osteogenin and bone sialoprotein
2 The second approach uses biomolecules with osteotropic
effects which range from mitogenicity (interleukin growth
factor-I FGF-2 platelet derived growth factor ndashBB) to the
increasing activity of the bone cells which enhances the
collagen synthesis for osteoinduction
Zirconia implants
Zirconia (Zr02) is a ceramic material used in implantology because
Biocompatibility(bio inert)
Esthetics (because its colour is similar to the teeth) and
Mechanical properties which are better than alumina
High resistance to corrosion flexion and fracture
Contact with bone and soft tissue similar to that observed in
titanium implants
It can be used to produce a entire implant or as a coating
Advantages of Zirconia Dental Implants
No dark colour of the metal showing through the gums
No corrosion of the zirconia as with titanium
No piezo-electric currents between dissimilar metal in
the mouth
It is thermally non-conductive
Greater BIC (Bone ndash Implant Contact)
20 more bone apposition than titanium implants
Zeynep Ouml zkurt Zirconia Dental Implants A Literature Review Journal of Oral Implantology Vol 37(3)2011
RTQ (removal torque testing) Gahlert et al evaluated the RTQ values of
machined zirconia implants sandblasted zirconia implants and SLA titanium
implants The mean RTQ for machined zirconia implants was 259 Ncm the
mean RTQ for zirconia rough implants was 405 Ncm and the mean RTQ for
SLA titanium implants was 1052 Ncm
Fracture strength within clinically acceptable limits
Stress analysis Kohal et al observed the stress distribution patterns of
zirconia implants (ReImplant) which were found to have low well distributed
and similar stress distribution compared with titanium implants
PEEK implants (poly etheretherketone)
These implants are available in three fundamentally different
designs
TAU Diameter -48 mm lengths 10 125 15 mm
immediate loading possible
Low density bone
THETA Similar to TAU but D1 bone
IOTA It is a 3mm diameter implant (10 and 12 mm)
used in narrow ridges
Advantages
Good strengthfracture resistance and bioinertness
Promotes human oseteoblast cell growth
Disadvantages
Faintly radiopaque ndashdifficult for post-op evaluation
Lengths and diameters range is restricted
Advances in
commercially
available implant
systems
LASER- LOK TECHNOLOGY
Unique surface characteristics
Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using
laser ablation technology
Extremely consistent microchannels that are optimally
sized to attach and organize both osteoblasts and
fibroblasts
Includes a repeating nanostructure that maximizes
surface area and enables cell pseudopodia and collagen
microfibrils to interdigitate with the Laser-Lok surface
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Software programs incorporating sophisticated
algorithms including back-filtered projection are applied
to these image data to generate a 3D volumetric data set
which can be used to provide primary reconstruction
images in 3 orthogonal planes (axial sagittal and coronal)
CBCT is devoted to maxillofacial area to scan and
visualize jaw bone lesions especially cancellous bone
It gives all the information of a CT but at 18th the
radiation dose and at a lower cost
CBCT is categorized into large medium and limited volume units based on the size
of their field of view (FOV)
Large (FOV)
bull 15-23 cm
bull Maxillofacial trauma
bull Orthodontic use
bull TMJ diseases
Medium FOV
bull 10-15 cm
bull Mandibulo-maxillary imaging
bull Pre-implant planning
bull Pathology
Small FOV
bull lt 10 cm
bull Endodontic applications
Advantages of CBCT
X-ray beam limitation
Image accuracy
Rapid scan time 10ndash70 seconds
Software can be made available to the user
Dose reduction Effective dose is 98 smaller than conventional CT
Reduced image artifact
Interactive computed tomography(ICT)
bullThis technique enables transfer of the imaging study to the
clinician as a computer filehellip
bullThe clinicianrsquos computer becomes a diagnostic radiologic
workstation with tools
bullAn important feature of ICT is that the clinician and radiologist can
perform ldquoelectronic surgeryrdquo (ES)
bull With an appropriately designed diagnostic
template ES can be performed to develop
the patientrsquos treatment plan electronically in
3 dimensions
bullTransfer of the plan to the patient at the
time of surgery can be accomplished by
production of the computer generated
three-dimensional stereotactic surgical
templates
Recent advances in
Computed Tomography(CT)
Microtomograph
Modification of CT it is specially useful in acquiring serial sections of bone
implant interface
Multi slice helical CT
The helical CT scan takes continuous pictures of the body in a rapid spiral motion
so that there are no gaps in the pictures collected
Recent Advances
in Implant Design
Mini implants
Mini dental implants (MDIs) are small diameter dental implants
Are sometimes referred to as SDIs (small diameter implants) as
well as NDIs (narrow body implants)
Diameter 18mm to 29mm (less than 3mm)
Various lengths 10 13 15 amp 18 mmrsquos
The MDI are available with either an O-ball head for use with
removable or fixed dentures or a square head for fixed prostheses or
retrofitting a poorly adapted partial denture
The body connects the tip with the prosthetic head and can be a
parallel sided cylinder or a progressively tapered cone
A small pilot bit is used to create the opening for the implant to be
threaded into the bone
The definitive implant supported crowns are usually delivered
within 2 weeks of surgery
Advantages
Immediate loading
Can be inserted in minimal tissues without relying on grafting
techniques
Minimally invasive procedure
One-stage denture stabilization
Does not require osteotomy
Cost-effective
Can be placed with a simple technique in patients with ridge too
narrow for conventional implants
Narrow-diameter implants Are they a predictable
treatment option A literature review
Joseacute-Luis Sierra-Saacutenchez Med Oral Patol Oral Cir Bucal 2014
Jan 119 (1)e74-81
The review included
Four randomized clinical trials
Ten prospective studies
Seven retrospective studies
The follow-up periods -12 months to 12 years
Total of 1607 patients
The patient age - 13 to 87 years
2980 implants
The recorded implant survival rates were above 90 in all the
studies Six studies published a survival rate of 100 at the end of
the follow-up period
The lowest survival rate (909) corresponded to the study
published by Barter et al
58 failures (implant loss) were recorded out of a total of 2980
implants
A larger number of failures were recorded with implants measuring
le 13 mm in length
Nineteen studies measured changes in peri-implant bone height
after implant loading 0065 mm the first year to 174 mm after a
follow-up period of 10 years
Araujo published a retrospective study on 33 mm implants placed
in posterior areas and rehabilitated following an immediate loading
protocol
Implant survival rate was 955 after 9 years of follow-up
That same year Degidi et al published a study comparing delayed
and immediate loading in narrow-diameter implants placed in both
anterior and posterior zones
Survival rate was 994 after a mean follow-up of 20 months
TRANSITIONAL IMPLANTS
Diameter ranges -18 to 28 mm
Length -7mm to 14mm
Fabricated with pure titanium in a single body with treated
surface
Primary function is to absorb masticatory stress during healing
phase
They should be placed at least 15 mm from adjacent teeth and
the distance between any transitional implant and a definitive
implant must be at least 15-2 mm
The abutment head generally has a 5 degree taper which makes it
optimal for retention of cement retained prostheses
Only one drill a 15 mm or 2 mm twist drill is required for
placement of the implants
Advantages
Provisionalisation of fully and partially edentulous jaws
Undisturbed healing of bone grafts
Effective way to generate aesthetic transitional appliances
Allows evaluation of phonetics and function
Cost effective
One ndash Piece Implants
The implant is machined from a piece of titanium that
incorporates both the implant body and an integral fixed abutment
in a single component
3 diameters -35 43 and 5 mm
4 lengths -10 13 15 and 16 mm
Clinical and radiographic evaluation of one-piece implants
used for immediate function
Jack a Hahn journal of oral implantology vol 33(3)2007
The aim of the present research was to evaluate the radiographic
outcome of a 1-piece implant when used for immediate function in
an ordinary patient pool
Forty-seven NobelDirect and NobelPerfect 1-piece implants
(Nobel Biocare Goumlteborg Sweden) were placed in maxillae and
mandibles
In this study 1 of the 47 implants had to be removed resulting in a
cumulative implant survival rate of 979 throughout the follow-up
period
The mean marginal bone level relative to the reference point after
1 year of loading (078 - 160 mm) as well as after 2 and 3 years of
loading was located above the first implant thread
In this study a bone level 2 mm apical to the reference point after
1 year of loading was observed at 2 implants (6)
The 1-piece implant design enables undisturbed healing
of the peri-implant soft tissue and avoids disruption of the
soft tissue seal when placing the definitive prosthetic
restoration
Annibali et al reported a series of patients treated
consecutively for first molar replacement according to
Immediate = group 1
Early = group 2
Late = Group 3
The implant survival rate
917 for early implants
950 for immediate post-extraction implants
100 for implants placed in healed sites
Short Dental Implants
A dental implant with length of 7 mm or less (Friberg et al 2000)
Any implant under 10 mm in length referred to as a lsquolsquoshortrsquorsquo
implant (Griffin TJ Cheung WS 2004)
A device with an intra-bony length of 8 mm or less (Renouard
and Nisand 2006)
Indication
Atropic Jaw
Proximity to vital structure
Single crowns
Overdentures
Advantages
1 Bone grafting for height often unnecessary
2 Less money pain and time prior to restoration of the implant
3 Simplified bone surgery
4 Implant insertion easier
Goodacre et al in 2003 reviewed
2754 implants - lt10 mm
3015 implants - gt10 mm in length
The failure rate of implants 10 mm or less was 10 compared
to a 3 failure rate of implants longer than 10 mm
Ivanoff et al in 1999 found an 8-mm-long 5-mm-diameter
implant failed 25 of the time in the maxilla and 33 of the
time in the mandible On the other hand the 10-mm and 12-
mm implants that were 5 mm in diameter reported no
mandibular failure and a 10 failure in the maxilla
Misch CE Short Dental Implants A Literature Review and Rationale for Use Dent Today 2005 Aug24(8)64-6 68
On the other hand a retrospective report by Misch et al was compiled
from 2 private offices using a square thread implant body design
(BioHorizons) rather than a v-shaped thread as primarily reported in the
previous literature
During a 3-year period 126 patients received implants less than 10 mm
long
Of the 437 implants there were 3 implant failures in the posterior
mandible and 1 failure in the posterior maxilla (99 survival)
All these failures were implants 9 mm long and 4 mm in diameter
Advances in Implant materials
Previously implants had macro-irregularities like macroscopic
threads fenestrations pores grooves steps threads or other
surface irregularities that were visible
However difficulty in achieving initial stability post implantation
relative motion adverse interfacial bone remodelling all lead to
search for improvement of the surface quality of a titanium dental
implant
BLASTING
Blasting -aluminium oxide titanium oxide and calcium phosphate
with particle size ranging from small medium to large (150- 350
microm)
Blasting a smooth Ti surface with Al2 O3 particles of 25 microm 75 microm
or 250 microm produces surfaces with roughness values of 116 to 120
143 and 194 to 220 respectively
A series of investigations have demonstrated a firmer bone
fixation of the implant with an average surface roughness (sa) of 1-
15microm than those of smoother implants with an average surface
roughness of 06microm
Blasting and Acid Etching
Acid etching can be done by using an HCL H2 SO4 mixture or by
pickling in 2 HF10HNO3 These processes leave pits and craters
Alumina or TiO2 for blasting the surface
Small - 25μm
large grit -025-05mm
medium grit - 250-500μm
Sand blasted and acid etched surfaces have a hydrophobic surface
The etching leads to the formation of Titanium hydrides and the
replacement of hydride by oxygen results in the slow transformation of
the implant surface resulting in nanometre sized particles of titanium on
the surface which helps in protein adhesion on implant surface
Dual acid etching with HCl and H2SO4 heated above 100ᴼC has
produced surface topography able to attach to fibrin scaffold and
promote adhesion of osteogenic cells
Sand blasting and etching can increase the rate and amount of the
bone formation
Flouride Surface Treatments
This treatment enhances osseointegration and osteoblastic
differentitation with increased expression of Cbfa1 osterix and
bone sialoprotein
Fluoridated rough implants also withstood greater push-out
forces and showed a significantly higher removal torque than
control implants
However detrimental effect of F on the corrosion resistance of
titanium and titanium alloys has been extensively reported
Anodized Surface Implants
Anodized surface implants are implants which are placed as anodes
in galvanic cells with phosphoric acid as the electrolyte and current is
passed through them ndash also ca ldquoTiunite surfacerdquo
The surface oxides grow from the native state of 5nm to
approximately 10000nm
The sa of TiUnite is reported to be 11microm and its sdr 37
Anodic oxidation results in the growth of a native titanium oxide
layer and a porous topography with the bone formation occurring
directly on the moderately rough oxidized surface
Clinical and Radiographic Evaluation of Braringnemark Implants with an
Anodized Surface following Seven-to-Eight Years of Functional Loading
David Gelb Bradley McaAllister et al Int J Dent 2013 2013 583567
The aim of this study was to evaluate the clinical and
radiographic long-term outcomes of dental implants with an
anodized TiUnite surface placed in routine clinical practice
38 single prosthesis
22 FPDs
80 implants in maxilla
27 in mandible
Mean marginal bone level change-149 plusmn 103 mm
907 of cases- no visible plaque93 -visible plaque
No prosthetic complication
Calandriello evaluated immediately placed anodized
implants in 33 patients and found a mean marginal bone
loss of 117thinspmm after 5 years
Friberg and Jemt compared 280 TiUnite implants to 110
machined implants in 111 patients and found marginal
bone loss after 5 years to be 075 and 06thinspmm respectively
with no significant difference between the two types of
implants
Laser etching and Micro Arc Oxidation
After the implants are ultrasonically cleaned they are laser etched
by using an NdYAG laser at a power of 50kw frequency of 75khz
and 164A current
They are then processed in an electrolyte solution with 35
glyceroposphate disodium salt pentahydrate and 12 calcium
acetate monohydrate by microarc oxidation (voltage 350v
frequency 800hz) for 15 seconds
Microarc oxidation produces a titania film with a porous structure
and micropores of 1-5microm
The mechanism of osseointegration of the oxidized implants has
been shown to be mechanical interlocking and biochemical
bonding
Surface coating Ti Plasma Spray
Porous rough Ti surface have been fabricated by plasma
spraying a Ti powder form of molten droplets at high temperature
at temperature in order of 15000C at 600ms
The Ti plasma spray after solidification often provides 004 ndash 005
mm thickness
Ti A spray has been reported to increase the surface area of bone
to implant interface (as much as 600) and stimulate adhesion
osteogenesis
Advantages
Enhance attachment by increasing ionic interactions
Increased load bearing capability by 25-30
Increased tensile strength through ingrowth of bony tissues into 3D feature
Disadvantages
Cracking and scaling of coating because of stresses produced by elevated temprature processing
Risk of accumulation of abraded material in the interface zone during implantation of TPS
Hydroxyapatite coatings
Hydroxyapatite [Ca10(PO4)6OH]2 coating was brought to the
dental profession by DeGroot
HA forms a strong chemical bond with bone due to the presence
of free calcium and phosphate compounds at the implant surface
The HA coating consists of amorphous and crystalline forms with
a large density of cracks
The top 1-2 microm of the HA layer being amorphous while the rest
of the crystalline layer is hexagonally packed
Indicated Fresh extraction sites
Newly grafted sites
Advantages
1 Protection of surrounding bone against metal ion release from the
substrate
2 Reported chemical bonding between HA and living bone-intimate
contact-biointegration
3 Partial dissolution of HA makes surrounding fluid rich in calcium
and phosphate ions which trigger cellular differentiation and bone
formation
Disadvantages
Induction of impurities due to thermal decomposition during
processing- affecting long term clinical fixation
Dissolution of HA at lower pH
HA coating on the implant surface (50-70microm) by various methods
1 Plasma spraying
2 The vacuum deposition technique(ion beam sputtering radiofrequency
sputtering)
3 The sol gel and dip coating method
4 Electrolytic process
Nanotitania coatings
Nanotitania coatings were prepared by using the sol-gel
technique
Nanotitania implants had an increased feature density and a large
feature coverage area as compared to the nano-HA implants
This could present more binding sites for the protein cell
attachment and for increased bone contact
he Nanotitania implants exhibited an ordered arrangement
forming a homogenous layer on underlying topography
Biologically active drugs incorporated dental
implants
Bisphosphonates Bisphosphate-loaded implant surfaces have
been reported to improve implant osseointegration
Simvastatin
Simvastatin could induce the expression of bone morphogenetic
protein (BMP) mRNA that might promote bone formation and
increase bone mineral density
Gentamycin along with the layer of HA can be coated onto the
implant surface which may act as a local prophylactic agent along
with the systemic antibiotics in dental implant surgery
Biochemical Methods
of the Surface
Modifications
Biochemical Methods of the Surface
Modifications
Their goal is to immobilize proteins enzymes or peptides on
biomaterials for the purpose of inducing specific cell and tissue
responses
1 One approach uses cell-adhesion molecules like fibronectin
vitronectin Type I collagen osteogenin and bone sialoprotein
2 The second approach uses biomolecules with osteotropic
effects which range from mitogenicity (interleukin growth
factor-I FGF-2 platelet derived growth factor ndashBB) to the
increasing activity of the bone cells which enhances the
collagen synthesis for osteoinduction
Zirconia implants
Zirconia (Zr02) is a ceramic material used in implantology because
Biocompatibility(bio inert)
Esthetics (because its colour is similar to the teeth) and
Mechanical properties which are better than alumina
High resistance to corrosion flexion and fracture
Contact with bone and soft tissue similar to that observed in
titanium implants
It can be used to produce a entire implant or as a coating
Advantages of Zirconia Dental Implants
No dark colour of the metal showing through the gums
No corrosion of the zirconia as with titanium
No piezo-electric currents between dissimilar metal in
the mouth
It is thermally non-conductive
Greater BIC (Bone ndash Implant Contact)
20 more bone apposition than titanium implants
Zeynep Ouml zkurt Zirconia Dental Implants A Literature Review Journal of Oral Implantology Vol 37(3)2011
RTQ (removal torque testing) Gahlert et al evaluated the RTQ values of
machined zirconia implants sandblasted zirconia implants and SLA titanium
implants The mean RTQ for machined zirconia implants was 259 Ncm the
mean RTQ for zirconia rough implants was 405 Ncm and the mean RTQ for
SLA titanium implants was 1052 Ncm
Fracture strength within clinically acceptable limits
Stress analysis Kohal et al observed the stress distribution patterns of
zirconia implants (ReImplant) which were found to have low well distributed
and similar stress distribution compared with titanium implants
PEEK implants (poly etheretherketone)
These implants are available in three fundamentally different
designs
TAU Diameter -48 mm lengths 10 125 15 mm
immediate loading possible
Low density bone
THETA Similar to TAU but D1 bone
IOTA It is a 3mm diameter implant (10 and 12 mm)
used in narrow ridges
Advantages
Good strengthfracture resistance and bioinertness
Promotes human oseteoblast cell growth
Disadvantages
Faintly radiopaque ndashdifficult for post-op evaluation
Lengths and diameters range is restricted
Advances in
commercially
available implant
systems
LASER- LOK TECHNOLOGY
Unique surface characteristics
Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using
laser ablation technology
Extremely consistent microchannels that are optimally
sized to attach and organize both osteoblasts and
fibroblasts
Includes a repeating nanostructure that maximizes
surface area and enables cell pseudopodia and collagen
microfibrils to interdigitate with the Laser-Lok surface
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
CBCT is categorized into large medium and limited volume units based on the size
of their field of view (FOV)
Large (FOV)
bull 15-23 cm
bull Maxillofacial trauma
bull Orthodontic use
bull TMJ diseases
Medium FOV
bull 10-15 cm
bull Mandibulo-maxillary imaging
bull Pre-implant planning
bull Pathology
Small FOV
bull lt 10 cm
bull Endodontic applications
Advantages of CBCT
X-ray beam limitation
Image accuracy
Rapid scan time 10ndash70 seconds
Software can be made available to the user
Dose reduction Effective dose is 98 smaller than conventional CT
Reduced image artifact
Interactive computed tomography(ICT)
bullThis technique enables transfer of the imaging study to the
clinician as a computer filehellip
bullThe clinicianrsquos computer becomes a diagnostic radiologic
workstation with tools
bullAn important feature of ICT is that the clinician and radiologist can
perform ldquoelectronic surgeryrdquo (ES)
bull With an appropriately designed diagnostic
template ES can be performed to develop
the patientrsquos treatment plan electronically in
3 dimensions
bullTransfer of the plan to the patient at the
time of surgery can be accomplished by
production of the computer generated
three-dimensional stereotactic surgical
templates
Recent advances in
Computed Tomography(CT)
Microtomograph
Modification of CT it is specially useful in acquiring serial sections of bone
implant interface
Multi slice helical CT
The helical CT scan takes continuous pictures of the body in a rapid spiral motion
so that there are no gaps in the pictures collected
Recent Advances
in Implant Design
Mini implants
Mini dental implants (MDIs) are small diameter dental implants
Are sometimes referred to as SDIs (small diameter implants) as
well as NDIs (narrow body implants)
Diameter 18mm to 29mm (less than 3mm)
Various lengths 10 13 15 amp 18 mmrsquos
The MDI are available with either an O-ball head for use with
removable or fixed dentures or a square head for fixed prostheses or
retrofitting a poorly adapted partial denture
The body connects the tip with the prosthetic head and can be a
parallel sided cylinder or a progressively tapered cone
A small pilot bit is used to create the opening for the implant to be
threaded into the bone
The definitive implant supported crowns are usually delivered
within 2 weeks of surgery
Advantages
Immediate loading
Can be inserted in minimal tissues without relying on grafting
techniques
Minimally invasive procedure
One-stage denture stabilization
Does not require osteotomy
Cost-effective
Can be placed with a simple technique in patients with ridge too
narrow for conventional implants
Narrow-diameter implants Are they a predictable
treatment option A literature review
Joseacute-Luis Sierra-Saacutenchez Med Oral Patol Oral Cir Bucal 2014
Jan 119 (1)e74-81
The review included
Four randomized clinical trials
Ten prospective studies
Seven retrospective studies
The follow-up periods -12 months to 12 years
Total of 1607 patients
The patient age - 13 to 87 years
2980 implants
The recorded implant survival rates were above 90 in all the
studies Six studies published a survival rate of 100 at the end of
the follow-up period
The lowest survival rate (909) corresponded to the study
published by Barter et al
58 failures (implant loss) were recorded out of a total of 2980
implants
A larger number of failures were recorded with implants measuring
le 13 mm in length
Nineteen studies measured changes in peri-implant bone height
after implant loading 0065 mm the first year to 174 mm after a
follow-up period of 10 years
Araujo published a retrospective study on 33 mm implants placed
in posterior areas and rehabilitated following an immediate loading
protocol
Implant survival rate was 955 after 9 years of follow-up
That same year Degidi et al published a study comparing delayed
and immediate loading in narrow-diameter implants placed in both
anterior and posterior zones
Survival rate was 994 after a mean follow-up of 20 months
TRANSITIONAL IMPLANTS
Diameter ranges -18 to 28 mm
Length -7mm to 14mm
Fabricated with pure titanium in a single body with treated
surface
Primary function is to absorb masticatory stress during healing
phase
They should be placed at least 15 mm from adjacent teeth and
the distance between any transitional implant and a definitive
implant must be at least 15-2 mm
The abutment head generally has a 5 degree taper which makes it
optimal for retention of cement retained prostheses
Only one drill a 15 mm or 2 mm twist drill is required for
placement of the implants
Advantages
Provisionalisation of fully and partially edentulous jaws
Undisturbed healing of bone grafts
Effective way to generate aesthetic transitional appliances
Allows evaluation of phonetics and function
Cost effective
One ndash Piece Implants
The implant is machined from a piece of titanium that
incorporates both the implant body and an integral fixed abutment
in a single component
3 diameters -35 43 and 5 mm
4 lengths -10 13 15 and 16 mm
Clinical and radiographic evaluation of one-piece implants
used for immediate function
Jack a Hahn journal of oral implantology vol 33(3)2007
The aim of the present research was to evaluate the radiographic
outcome of a 1-piece implant when used for immediate function in
an ordinary patient pool
Forty-seven NobelDirect and NobelPerfect 1-piece implants
(Nobel Biocare Goumlteborg Sweden) were placed in maxillae and
mandibles
In this study 1 of the 47 implants had to be removed resulting in a
cumulative implant survival rate of 979 throughout the follow-up
period
The mean marginal bone level relative to the reference point after
1 year of loading (078 - 160 mm) as well as after 2 and 3 years of
loading was located above the first implant thread
In this study a bone level 2 mm apical to the reference point after
1 year of loading was observed at 2 implants (6)
The 1-piece implant design enables undisturbed healing
of the peri-implant soft tissue and avoids disruption of the
soft tissue seal when placing the definitive prosthetic
restoration
Annibali et al reported a series of patients treated
consecutively for first molar replacement according to
Immediate = group 1
Early = group 2
Late = Group 3
The implant survival rate
917 for early implants
950 for immediate post-extraction implants
100 for implants placed in healed sites
Short Dental Implants
A dental implant with length of 7 mm or less (Friberg et al 2000)
Any implant under 10 mm in length referred to as a lsquolsquoshortrsquorsquo
implant (Griffin TJ Cheung WS 2004)
A device with an intra-bony length of 8 mm or less (Renouard
and Nisand 2006)
Indication
Atropic Jaw
Proximity to vital structure
Single crowns
Overdentures
Advantages
1 Bone grafting for height often unnecessary
2 Less money pain and time prior to restoration of the implant
3 Simplified bone surgery
4 Implant insertion easier
Goodacre et al in 2003 reviewed
2754 implants - lt10 mm
3015 implants - gt10 mm in length
The failure rate of implants 10 mm or less was 10 compared
to a 3 failure rate of implants longer than 10 mm
Ivanoff et al in 1999 found an 8-mm-long 5-mm-diameter
implant failed 25 of the time in the maxilla and 33 of the
time in the mandible On the other hand the 10-mm and 12-
mm implants that were 5 mm in diameter reported no
mandibular failure and a 10 failure in the maxilla
Misch CE Short Dental Implants A Literature Review and Rationale for Use Dent Today 2005 Aug24(8)64-6 68
On the other hand a retrospective report by Misch et al was compiled
from 2 private offices using a square thread implant body design
(BioHorizons) rather than a v-shaped thread as primarily reported in the
previous literature
During a 3-year period 126 patients received implants less than 10 mm
long
Of the 437 implants there were 3 implant failures in the posterior
mandible and 1 failure in the posterior maxilla (99 survival)
All these failures were implants 9 mm long and 4 mm in diameter
Advances in Implant materials
Previously implants had macro-irregularities like macroscopic
threads fenestrations pores grooves steps threads or other
surface irregularities that were visible
However difficulty in achieving initial stability post implantation
relative motion adverse interfacial bone remodelling all lead to
search for improvement of the surface quality of a titanium dental
implant
BLASTING
Blasting -aluminium oxide titanium oxide and calcium phosphate
with particle size ranging from small medium to large (150- 350
microm)
Blasting a smooth Ti surface with Al2 O3 particles of 25 microm 75 microm
or 250 microm produces surfaces with roughness values of 116 to 120
143 and 194 to 220 respectively
A series of investigations have demonstrated a firmer bone
fixation of the implant with an average surface roughness (sa) of 1-
15microm than those of smoother implants with an average surface
roughness of 06microm
Blasting and Acid Etching
Acid etching can be done by using an HCL H2 SO4 mixture or by
pickling in 2 HF10HNO3 These processes leave pits and craters
Alumina or TiO2 for blasting the surface
Small - 25μm
large grit -025-05mm
medium grit - 250-500μm
Sand blasted and acid etched surfaces have a hydrophobic surface
The etching leads to the formation of Titanium hydrides and the
replacement of hydride by oxygen results in the slow transformation of
the implant surface resulting in nanometre sized particles of titanium on
the surface which helps in protein adhesion on implant surface
Dual acid etching with HCl and H2SO4 heated above 100ᴼC has
produced surface topography able to attach to fibrin scaffold and
promote adhesion of osteogenic cells
Sand blasting and etching can increase the rate and amount of the
bone formation
Flouride Surface Treatments
This treatment enhances osseointegration and osteoblastic
differentitation with increased expression of Cbfa1 osterix and
bone sialoprotein
Fluoridated rough implants also withstood greater push-out
forces and showed a significantly higher removal torque than
control implants
However detrimental effect of F on the corrosion resistance of
titanium and titanium alloys has been extensively reported
Anodized Surface Implants
Anodized surface implants are implants which are placed as anodes
in galvanic cells with phosphoric acid as the electrolyte and current is
passed through them ndash also ca ldquoTiunite surfacerdquo
The surface oxides grow from the native state of 5nm to
approximately 10000nm
The sa of TiUnite is reported to be 11microm and its sdr 37
Anodic oxidation results in the growth of a native titanium oxide
layer and a porous topography with the bone formation occurring
directly on the moderately rough oxidized surface
Clinical and Radiographic Evaluation of Braringnemark Implants with an
Anodized Surface following Seven-to-Eight Years of Functional Loading
David Gelb Bradley McaAllister et al Int J Dent 2013 2013 583567
The aim of this study was to evaluate the clinical and
radiographic long-term outcomes of dental implants with an
anodized TiUnite surface placed in routine clinical practice
38 single prosthesis
22 FPDs
80 implants in maxilla
27 in mandible
Mean marginal bone level change-149 plusmn 103 mm
907 of cases- no visible plaque93 -visible plaque
No prosthetic complication
Calandriello evaluated immediately placed anodized
implants in 33 patients and found a mean marginal bone
loss of 117thinspmm after 5 years
Friberg and Jemt compared 280 TiUnite implants to 110
machined implants in 111 patients and found marginal
bone loss after 5 years to be 075 and 06thinspmm respectively
with no significant difference between the two types of
implants
Laser etching and Micro Arc Oxidation
After the implants are ultrasonically cleaned they are laser etched
by using an NdYAG laser at a power of 50kw frequency of 75khz
and 164A current
They are then processed in an electrolyte solution with 35
glyceroposphate disodium salt pentahydrate and 12 calcium
acetate monohydrate by microarc oxidation (voltage 350v
frequency 800hz) for 15 seconds
Microarc oxidation produces a titania film with a porous structure
and micropores of 1-5microm
The mechanism of osseointegration of the oxidized implants has
been shown to be mechanical interlocking and biochemical
bonding
Surface coating Ti Plasma Spray
Porous rough Ti surface have been fabricated by plasma
spraying a Ti powder form of molten droplets at high temperature
at temperature in order of 15000C at 600ms
The Ti plasma spray after solidification often provides 004 ndash 005
mm thickness
Ti A spray has been reported to increase the surface area of bone
to implant interface (as much as 600) and stimulate adhesion
osteogenesis
Advantages
Enhance attachment by increasing ionic interactions
Increased load bearing capability by 25-30
Increased tensile strength through ingrowth of bony tissues into 3D feature
Disadvantages
Cracking and scaling of coating because of stresses produced by elevated temprature processing
Risk of accumulation of abraded material in the interface zone during implantation of TPS
Hydroxyapatite coatings
Hydroxyapatite [Ca10(PO4)6OH]2 coating was brought to the
dental profession by DeGroot
HA forms a strong chemical bond with bone due to the presence
of free calcium and phosphate compounds at the implant surface
The HA coating consists of amorphous and crystalline forms with
a large density of cracks
The top 1-2 microm of the HA layer being amorphous while the rest
of the crystalline layer is hexagonally packed
Indicated Fresh extraction sites
Newly grafted sites
Advantages
1 Protection of surrounding bone against metal ion release from the
substrate
2 Reported chemical bonding between HA and living bone-intimate
contact-biointegration
3 Partial dissolution of HA makes surrounding fluid rich in calcium
and phosphate ions which trigger cellular differentiation and bone
formation
Disadvantages
Induction of impurities due to thermal decomposition during
processing- affecting long term clinical fixation
Dissolution of HA at lower pH
HA coating on the implant surface (50-70microm) by various methods
1 Plasma spraying
2 The vacuum deposition technique(ion beam sputtering radiofrequency
sputtering)
3 The sol gel and dip coating method
4 Electrolytic process
Nanotitania coatings
Nanotitania coatings were prepared by using the sol-gel
technique
Nanotitania implants had an increased feature density and a large
feature coverage area as compared to the nano-HA implants
This could present more binding sites for the protein cell
attachment and for increased bone contact
he Nanotitania implants exhibited an ordered arrangement
forming a homogenous layer on underlying topography
Biologically active drugs incorporated dental
implants
Bisphosphonates Bisphosphate-loaded implant surfaces have
been reported to improve implant osseointegration
Simvastatin
Simvastatin could induce the expression of bone morphogenetic
protein (BMP) mRNA that might promote bone formation and
increase bone mineral density
Gentamycin along with the layer of HA can be coated onto the
implant surface which may act as a local prophylactic agent along
with the systemic antibiotics in dental implant surgery
Biochemical Methods
of the Surface
Modifications
Biochemical Methods of the Surface
Modifications
Their goal is to immobilize proteins enzymes or peptides on
biomaterials for the purpose of inducing specific cell and tissue
responses
1 One approach uses cell-adhesion molecules like fibronectin
vitronectin Type I collagen osteogenin and bone sialoprotein
2 The second approach uses biomolecules with osteotropic
effects which range from mitogenicity (interleukin growth
factor-I FGF-2 platelet derived growth factor ndashBB) to the
increasing activity of the bone cells which enhances the
collagen synthesis for osteoinduction
Zirconia implants
Zirconia (Zr02) is a ceramic material used in implantology because
Biocompatibility(bio inert)
Esthetics (because its colour is similar to the teeth) and
Mechanical properties which are better than alumina
High resistance to corrosion flexion and fracture
Contact with bone and soft tissue similar to that observed in
titanium implants
It can be used to produce a entire implant or as a coating
Advantages of Zirconia Dental Implants
No dark colour of the metal showing through the gums
No corrosion of the zirconia as with titanium
No piezo-electric currents between dissimilar metal in
the mouth
It is thermally non-conductive
Greater BIC (Bone ndash Implant Contact)
20 more bone apposition than titanium implants
Zeynep Ouml zkurt Zirconia Dental Implants A Literature Review Journal of Oral Implantology Vol 37(3)2011
RTQ (removal torque testing) Gahlert et al evaluated the RTQ values of
machined zirconia implants sandblasted zirconia implants and SLA titanium
implants The mean RTQ for machined zirconia implants was 259 Ncm the
mean RTQ for zirconia rough implants was 405 Ncm and the mean RTQ for
SLA titanium implants was 1052 Ncm
Fracture strength within clinically acceptable limits
Stress analysis Kohal et al observed the stress distribution patterns of
zirconia implants (ReImplant) which were found to have low well distributed
and similar stress distribution compared with titanium implants
PEEK implants (poly etheretherketone)
These implants are available in three fundamentally different
designs
TAU Diameter -48 mm lengths 10 125 15 mm
immediate loading possible
Low density bone
THETA Similar to TAU but D1 bone
IOTA It is a 3mm diameter implant (10 and 12 mm)
used in narrow ridges
Advantages
Good strengthfracture resistance and bioinertness
Promotes human oseteoblast cell growth
Disadvantages
Faintly radiopaque ndashdifficult for post-op evaluation
Lengths and diameters range is restricted
Advances in
commercially
available implant
systems
LASER- LOK TECHNOLOGY
Unique surface characteristics
Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using
laser ablation technology
Extremely consistent microchannels that are optimally
sized to attach and organize both osteoblasts and
fibroblasts
Includes a repeating nanostructure that maximizes
surface area and enables cell pseudopodia and collagen
microfibrils to interdigitate with the Laser-Lok surface
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Advantages of CBCT
X-ray beam limitation
Image accuracy
Rapid scan time 10ndash70 seconds
Software can be made available to the user
Dose reduction Effective dose is 98 smaller than conventional CT
Reduced image artifact
Interactive computed tomography(ICT)
bullThis technique enables transfer of the imaging study to the
clinician as a computer filehellip
bullThe clinicianrsquos computer becomes a diagnostic radiologic
workstation with tools
bullAn important feature of ICT is that the clinician and radiologist can
perform ldquoelectronic surgeryrdquo (ES)
bull With an appropriately designed diagnostic
template ES can be performed to develop
the patientrsquos treatment plan electronically in
3 dimensions
bullTransfer of the plan to the patient at the
time of surgery can be accomplished by
production of the computer generated
three-dimensional stereotactic surgical
templates
Recent advances in
Computed Tomography(CT)
Microtomograph
Modification of CT it is specially useful in acquiring serial sections of bone
implant interface
Multi slice helical CT
The helical CT scan takes continuous pictures of the body in a rapid spiral motion
so that there are no gaps in the pictures collected
Recent Advances
in Implant Design
Mini implants
Mini dental implants (MDIs) are small diameter dental implants
Are sometimes referred to as SDIs (small diameter implants) as
well as NDIs (narrow body implants)
Diameter 18mm to 29mm (less than 3mm)
Various lengths 10 13 15 amp 18 mmrsquos
The MDI are available with either an O-ball head for use with
removable or fixed dentures or a square head for fixed prostheses or
retrofitting a poorly adapted partial denture
The body connects the tip with the prosthetic head and can be a
parallel sided cylinder or a progressively tapered cone
A small pilot bit is used to create the opening for the implant to be
threaded into the bone
The definitive implant supported crowns are usually delivered
within 2 weeks of surgery
Advantages
Immediate loading
Can be inserted in minimal tissues without relying on grafting
techniques
Minimally invasive procedure
One-stage denture stabilization
Does not require osteotomy
Cost-effective
Can be placed with a simple technique in patients with ridge too
narrow for conventional implants
Narrow-diameter implants Are they a predictable
treatment option A literature review
Joseacute-Luis Sierra-Saacutenchez Med Oral Patol Oral Cir Bucal 2014
Jan 119 (1)e74-81
The review included
Four randomized clinical trials
Ten prospective studies
Seven retrospective studies
The follow-up periods -12 months to 12 years
Total of 1607 patients
The patient age - 13 to 87 years
2980 implants
The recorded implant survival rates were above 90 in all the
studies Six studies published a survival rate of 100 at the end of
the follow-up period
The lowest survival rate (909) corresponded to the study
published by Barter et al
58 failures (implant loss) were recorded out of a total of 2980
implants
A larger number of failures were recorded with implants measuring
le 13 mm in length
Nineteen studies measured changes in peri-implant bone height
after implant loading 0065 mm the first year to 174 mm after a
follow-up period of 10 years
Araujo published a retrospective study on 33 mm implants placed
in posterior areas and rehabilitated following an immediate loading
protocol
Implant survival rate was 955 after 9 years of follow-up
That same year Degidi et al published a study comparing delayed
and immediate loading in narrow-diameter implants placed in both
anterior and posterior zones
Survival rate was 994 after a mean follow-up of 20 months
TRANSITIONAL IMPLANTS
Diameter ranges -18 to 28 mm
Length -7mm to 14mm
Fabricated with pure titanium in a single body with treated
surface
Primary function is to absorb masticatory stress during healing
phase
They should be placed at least 15 mm from adjacent teeth and
the distance between any transitional implant and a definitive
implant must be at least 15-2 mm
The abutment head generally has a 5 degree taper which makes it
optimal for retention of cement retained prostheses
Only one drill a 15 mm or 2 mm twist drill is required for
placement of the implants
Advantages
Provisionalisation of fully and partially edentulous jaws
Undisturbed healing of bone grafts
Effective way to generate aesthetic transitional appliances
Allows evaluation of phonetics and function
Cost effective
One ndash Piece Implants
The implant is machined from a piece of titanium that
incorporates both the implant body and an integral fixed abutment
in a single component
3 diameters -35 43 and 5 mm
4 lengths -10 13 15 and 16 mm
Clinical and radiographic evaluation of one-piece implants
used for immediate function
Jack a Hahn journal of oral implantology vol 33(3)2007
The aim of the present research was to evaluate the radiographic
outcome of a 1-piece implant when used for immediate function in
an ordinary patient pool
Forty-seven NobelDirect and NobelPerfect 1-piece implants
(Nobel Biocare Goumlteborg Sweden) were placed in maxillae and
mandibles
In this study 1 of the 47 implants had to be removed resulting in a
cumulative implant survival rate of 979 throughout the follow-up
period
The mean marginal bone level relative to the reference point after
1 year of loading (078 - 160 mm) as well as after 2 and 3 years of
loading was located above the first implant thread
In this study a bone level 2 mm apical to the reference point after
1 year of loading was observed at 2 implants (6)
The 1-piece implant design enables undisturbed healing
of the peri-implant soft tissue and avoids disruption of the
soft tissue seal when placing the definitive prosthetic
restoration
Annibali et al reported a series of patients treated
consecutively for first molar replacement according to
Immediate = group 1
Early = group 2
Late = Group 3
The implant survival rate
917 for early implants
950 for immediate post-extraction implants
100 for implants placed in healed sites
Short Dental Implants
A dental implant with length of 7 mm or less (Friberg et al 2000)
Any implant under 10 mm in length referred to as a lsquolsquoshortrsquorsquo
implant (Griffin TJ Cheung WS 2004)
A device with an intra-bony length of 8 mm or less (Renouard
and Nisand 2006)
Indication
Atropic Jaw
Proximity to vital structure
Single crowns
Overdentures
Advantages
1 Bone grafting for height often unnecessary
2 Less money pain and time prior to restoration of the implant
3 Simplified bone surgery
4 Implant insertion easier
Goodacre et al in 2003 reviewed
2754 implants - lt10 mm
3015 implants - gt10 mm in length
The failure rate of implants 10 mm or less was 10 compared
to a 3 failure rate of implants longer than 10 mm
Ivanoff et al in 1999 found an 8-mm-long 5-mm-diameter
implant failed 25 of the time in the maxilla and 33 of the
time in the mandible On the other hand the 10-mm and 12-
mm implants that were 5 mm in diameter reported no
mandibular failure and a 10 failure in the maxilla
Misch CE Short Dental Implants A Literature Review and Rationale for Use Dent Today 2005 Aug24(8)64-6 68
On the other hand a retrospective report by Misch et al was compiled
from 2 private offices using a square thread implant body design
(BioHorizons) rather than a v-shaped thread as primarily reported in the
previous literature
During a 3-year period 126 patients received implants less than 10 mm
long
Of the 437 implants there were 3 implant failures in the posterior
mandible and 1 failure in the posterior maxilla (99 survival)
All these failures were implants 9 mm long and 4 mm in diameter
Advances in Implant materials
Previously implants had macro-irregularities like macroscopic
threads fenestrations pores grooves steps threads or other
surface irregularities that were visible
However difficulty in achieving initial stability post implantation
relative motion adverse interfacial bone remodelling all lead to
search for improvement of the surface quality of a titanium dental
implant
BLASTING
Blasting -aluminium oxide titanium oxide and calcium phosphate
with particle size ranging from small medium to large (150- 350
microm)
Blasting a smooth Ti surface with Al2 O3 particles of 25 microm 75 microm
or 250 microm produces surfaces with roughness values of 116 to 120
143 and 194 to 220 respectively
A series of investigations have demonstrated a firmer bone
fixation of the implant with an average surface roughness (sa) of 1-
15microm than those of smoother implants with an average surface
roughness of 06microm
Blasting and Acid Etching
Acid etching can be done by using an HCL H2 SO4 mixture or by
pickling in 2 HF10HNO3 These processes leave pits and craters
Alumina or TiO2 for blasting the surface
Small - 25μm
large grit -025-05mm
medium grit - 250-500μm
Sand blasted and acid etched surfaces have a hydrophobic surface
The etching leads to the formation of Titanium hydrides and the
replacement of hydride by oxygen results in the slow transformation of
the implant surface resulting in nanometre sized particles of titanium on
the surface which helps in protein adhesion on implant surface
Dual acid etching with HCl and H2SO4 heated above 100ᴼC has
produced surface topography able to attach to fibrin scaffold and
promote adhesion of osteogenic cells
Sand blasting and etching can increase the rate and amount of the
bone formation
Flouride Surface Treatments
This treatment enhances osseointegration and osteoblastic
differentitation with increased expression of Cbfa1 osterix and
bone sialoprotein
Fluoridated rough implants also withstood greater push-out
forces and showed a significantly higher removal torque than
control implants
However detrimental effect of F on the corrosion resistance of
titanium and titanium alloys has been extensively reported
Anodized Surface Implants
Anodized surface implants are implants which are placed as anodes
in galvanic cells with phosphoric acid as the electrolyte and current is
passed through them ndash also ca ldquoTiunite surfacerdquo
The surface oxides grow from the native state of 5nm to
approximately 10000nm
The sa of TiUnite is reported to be 11microm and its sdr 37
Anodic oxidation results in the growth of a native titanium oxide
layer and a porous topography with the bone formation occurring
directly on the moderately rough oxidized surface
Clinical and Radiographic Evaluation of Braringnemark Implants with an
Anodized Surface following Seven-to-Eight Years of Functional Loading
David Gelb Bradley McaAllister et al Int J Dent 2013 2013 583567
The aim of this study was to evaluate the clinical and
radiographic long-term outcomes of dental implants with an
anodized TiUnite surface placed in routine clinical practice
38 single prosthesis
22 FPDs
80 implants in maxilla
27 in mandible
Mean marginal bone level change-149 plusmn 103 mm
907 of cases- no visible plaque93 -visible plaque
No prosthetic complication
Calandriello evaluated immediately placed anodized
implants in 33 patients and found a mean marginal bone
loss of 117thinspmm after 5 years
Friberg and Jemt compared 280 TiUnite implants to 110
machined implants in 111 patients and found marginal
bone loss after 5 years to be 075 and 06thinspmm respectively
with no significant difference between the two types of
implants
Laser etching and Micro Arc Oxidation
After the implants are ultrasonically cleaned they are laser etched
by using an NdYAG laser at a power of 50kw frequency of 75khz
and 164A current
They are then processed in an electrolyte solution with 35
glyceroposphate disodium salt pentahydrate and 12 calcium
acetate monohydrate by microarc oxidation (voltage 350v
frequency 800hz) for 15 seconds
Microarc oxidation produces a titania film with a porous structure
and micropores of 1-5microm
The mechanism of osseointegration of the oxidized implants has
been shown to be mechanical interlocking and biochemical
bonding
Surface coating Ti Plasma Spray
Porous rough Ti surface have been fabricated by plasma
spraying a Ti powder form of molten droplets at high temperature
at temperature in order of 15000C at 600ms
The Ti plasma spray after solidification often provides 004 ndash 005
mm thickness
Ti A spray has been reported to increase the surface area of bone
to implant interface (as much as 600) and stimulate adhesion
osteogenesis
Advantages
Enhance attachment by increasing ionic interactions
Increased load bearing capability by 25-30
Increased tensile strength through ingrowth of bony tissues into 3D feature
Disadvantages
Cracking and scaling of coating because of stresses produced by elevated temprature processing
Risk of accumulation of abraded material in the interface zone during implantation of TPS
Hydroxyapatite coatings
Hydroxyapatite [Ca10(PO4)6OH]2 coating was brought to the
dental profession by DeGroot
HA forms a strong chemical bond with bone due to the presence
of free calcium and phosphate compounds at the implant surface
The HA coating consists of amorphous and crystalline forms with
a large density of cracks
The top 1-2 microm of the HA layer being amorphous while the rest
of the crystalline layer is hexagonally packed
Indicated Fresh extraction sites
Newly grafted sites
Advantages
1 Protection of surrounding bone against metal ion release from the
substrate
2 Reported chemical bonding between HA and living bone-intimate
contact-biointegration
3 Partial dissolution of HA makes surrounding fluid rich in calcium
and phosphate ions which trigger cellular differentiation and bone
formation
Disadvantages
Induction of impurities due to thermal decomposition during
processing- affecting long term clinical fixation
Dissolution of HA at lower pH
HA coating on the implant surface (50-70microm) by various methods
1 Plasma spraying
2 The vacuum deposition technique(ion beam sputtering radiofrequency
sputtering)
3 The sol gel and dip coating method
4 Electrolytic process
Nanotitania coatings
Nanotitania coatings were prepared by using the sol-gel
technique
Nanotitania implants had an increased feature density and a large
feature coverage area as compared to the nano-HA implants
This could present more binding sites for the protein cell
attachment and for increased bone contact
he Nanotitania implants exhibited an ordered arrangement
forming a homogenous layer on underlying topography
Biologically active drugs incorporated dental
implants
Bisphosphonates Bisphosphate-loaded implant surfaces have
been reported to improve implant osseointegration
Simvastatin
Simvastatin could induce the expression of bone morphogenetic
protein (BMP) mRNA that might promote bone formation and
increase bone mineral density
Gentamycin along with the layer of HA can be coated onto the
implant surface which may act as a local prophylactic agent along
with the systemic antibiotics in dental implant surgery
Biochemical Methods
of the Surface
Modifications
Biochemical Methods of the Surface
Modifications
Their goal is to immobilize proteins enzymes or peptides on
biomaterials for the purpose of inducing specific cell and tissue
responses
1 One approach uses cell-adhesion molecules like fibronectin
vitronectin Type I collagen osteogenin and bone sialoprotein
2 The second approach uses biomolecules with osteotropic
effects which range from mitogenicity (interleukin growth
factor-I FGF-2 platelet derived growth factor ndashBB) to the
increasing activity of the bone cells which enhances the
collagen synthesis for osteoinduction
Zirconia implants
Zirconia (Zr02) is a ceramic material used in implantology because
Biocompatibility(bio inert)
Esthetics (because its colour is similar to the teeth) and
Mechanical properties which are better than alumina
High resistance to corrosion flexion and fracture
Contact with bone and soft tissue similar to that observed in
titanium implants
It can be used to produce a entire implant or as a coating
Advantages of Zirconia Dental Implants
No dark colour of the metal showing through the gums
No corrosion of the zirconia as with titanium
No piezo-electric currents between dissimilar metal in
the mouth
It is thermally non-conductive
Greater BIC (Bone ndash Implant Contact)
20 more bone apposition than titanium implants
Zeynep Ouml zkurt Zirconia Dental Implants A Literature Review Journal of Oral Implantology Vol 37(3)2011
RTQ (removal torque testing) Gahlert et al evaluated the RTQ values of
machined zirconia implants sandblasted zirconia implants and SLA titanium
implants The mean RTQ for machined zirconia implants was 259 Ncm the
mean RTQ for zirconia rough implants was 405 Ncm and the mean RTQ for
SLA titanium implants was 1052 Ncm
Fracture strength within clinically acceptable limits
Stress analysis Kohal et al observed the stress distribution patterns of
zirconia implants (ReImplant) which were found to have low well distributed
and similar stress distribution compared with titanium implants
PEEK implants (poly etheretherketone)
These implants are available in three fundamentally different
designs
TAU Diameter -48 mm lengths 10 125 15 mm
immediate loading possible
Low density bone
THETA Similar to TAU but D1 bone
IOTA It is a 3mm diameter implant (10 and 12 mm)
used in narrow ridges
Advantages
Good strengthfracture resistance and bioinertness
Promotes human oseteoblast cell growth
Disadvantages
Faintly radiopaque ndashdifficult for post-op evaluation
Lengths and diameters range is restricted
Advances in
commercially
available implant
systems
LASER- LOK TECHNOLOGY
Unique surface characteristics
Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using
laser ablation technology
Extremely consistent microchannels that are optimally
sized to attach and organize both osteoblasts and
fibroblasts
Includes a repeating nanostructure that maximizes
surface area and enables cell pseudopodia and collagen
microfibrils to interdigitate with the Laser-Lok surface
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Interactive computed tomography(ICT)
bullThis technique enables transfer of the imaging study to the
clinician as a computer filehellip
bullThe clinicianrsquos computer becomes a diagnostic radiologic
workstation with tools
bullAn important feature of ICT is that the clinician and radiologist can
perform ldquoelectronic surgeryrdquo (ES)
bull With an appropriately designed diagnostic
template ES can be performed to develop
the patientrsquos treatment plan electronically in
3 dimensions
bullTransfer of the plan to the patient at the
time of surgery can be accomplished by
production of the computer generated
three-dimensional stereotactic surgical
templates
Recent advances in
Computed Tomography(CT)
Microtomograph
Modification of CT it is specially useful in acquiring serial sections of bone
implant interface
Multi slice helical CT
The helical CT scan takes continuous pictures of the body in a rapid spiral motion
so that there are no gaps in the pictures collected
Recent Advances
in Implant Design
Mini implants
Mini dental implants (MDIs) are small diameter dental implants
Are sometimes referred to as SDIs (small diameter implants) as
well as NDIs (narrow body implants)
Diameter 18mm to 29mm (less than 3mm)
Various lengths 10 13 15 amp 18 mmrsquos
The MDI are available with either an O-ball head for use with
removable or fixed dentures or a square head for fixed prostheses or
retrofitting a poorly adapted partial denture
The body connects the tip with the prosthetic head and can be a
parallel sided cylinder or a progressively tapered cone
A small pilot bit is used to create the opening for the implant to be
threaded into the bone
The definitive implant supported crowns are usually delivered
within 2 weeks of surgery
Advantages
Immediate loading
Can be inserted in minimal tissues without relying on grafting
techniques
Minimally invasive procedure
One-stage denture stabilization
Does not require osteotomy
Cost-effective
Can be placed with a simple technique in patients with ridge too
narrow for conventional implants
Narrow-diameter implants Are they a predictable
treatment option A literature review
Joseacute-Luis Sierra-Saacutenchez Med Oral Patol Oral Cir Bucal 2014
Jan 119 (1)e74-81
The review included
Four randomized clinical trials
Ten prospective studies
Seven retrospective studies
The follow-up periods -12 months to 12 years
Total of 1607 patients
The patient age - 13 to 87 years
2980 implants
The recorded implant survival rates were above 90 in all the
studies Six studies published a survival rate of 100 at the end of
the follow-up period
The lowest survival rate (909) corresponded to the study
published by Barter et al
58 failures (implant loss) were recorded out of a total of 2980
implants
A larger number of failures were recorded with implants measuring
le 13 mm in length
Nineteen studies measured changes in peri-implant bone height
after implant loading 0065 mm the first year to 174 mm after a
follow-up period of 10 years
Araujo published a retrospective study on 33 mm implants placed
in posterior areas and rehabilitated following an immediate loading
protocol
Implant survival rate was 955 after 9 years of follow-up
That same year Degidi et al published a study comparing delayed
and immediate loading in narrow-diameter implants placed in both
anterior and posterior zones
Survival rate was 994 after a mean follow-up of 20 months
TRANSITIONAL IMPLANTS
Diameter ranges -18 to 28 mm
Length -7mm to 14mm
Fabricated with pure titanium in a single body with treated
surface
Primary function is to absorb masticatory stress during healing
phase
They should be placed at least 15 mm from adjacent teeth and
the distance between any transitional implant and a definitive
implant must be at least 15-2 mm
The abutment head generally has a 5 degree taper which makes it
optimal for retention of cement retained prostheses
Only one drill a 15 mm or 2 mm twist drill is required for
placement of the implants
Advantages
Provisionalisation of fully and partially edentulous jaws
Undisturbed healing of bone grafts
Effective way to generate aesthetic transitional appliances
Allows evaluation of phonetics and function
Cost effective
One ndash Piece Implants
The implant is machined from a piece of titanium that
incorporates both the implant body and an integral fixed abutment
in a single component
3 diameters -35 43 and 5 mm
4 lengths -10 13 15 and 16 mm
Clinical and radiographic evaluation of one-piece implants
used for immediate function
Jack a Hahn journal of oral implantology vol 33(3)2007
The aim of the present research was to evaluate the radiographic
outcome of a 1-piece implant when used for immediate function in
an ordinary patient pool
Forty-seven NobelDirect and NobelPerfect 1-piece implants
(Nobel Biocare Goumlteborg Sweden) were placed in maxillae and
mandibles
In this study 1 of the 47 implants had to be removed resulting in a
cumulative implant survival rate of 979 throughout the follow-up
period
The mean marginal bone level relative to the reference point after
1 year of loading (078 - 160 mm) as well as after 2 and 3 years of
loading was located above the first implant thread
In this study a bone level 2 mm apical to the reference point after
1 year of loading was observed at 2 implants (6)
The 1-piece implant design enables undisturbed healing
of the peri-implant soft tissue and avoids disruption of the
soft tissue seal when placing the definitive prosthetic
restoration
Annibali et al reported a series of patients treated
consecutively for first molar replacement according to
Immediate = group 1
Early = group 2
Late = Group 3
The implant survival rate
917 for early implants
950 for immediate post-extraction implants
100 for implants placed in healed sites
Short Dental Implants
A dental implant with length of 7 mm or less (Friberg et al 2000)
Any implant under 10 mm in length referred to as a lsquolsquoshortrsquorsquo
implant (Griffin TJ Cheung WS 2004)
A device with an intra-bony length of 8 mm or less (Renouard
and Nisand 2006)
Indication
Atropic Jaw
Proximity to vital structure
Single crowns
Overdentures
Advantages
1 Bone grafting for height often unnecessary
2 Less money pain and time prior to restoration of the implant
3 Simplified bone surgery
4 Implant insertion easier
Goodacre et al in 2003 reviewed
2754 implants - lt10 mm
3015 implants - gt10 mm in length
The failure rate of implants 10 mm or less was 10 compared
to a 3 failure rate of implants longer than 10 mm
Ivanoff et al in 1999 found an 8-mm-long 5-mm-diameter
implant failed 25 of the time in the maxilla and 33 of the
time in the mandible On the other hand the 10-mm and 12-
mm implants that were 5 mm in diameter reported no
mandibular failure and a 10 failure in the maxilla
Misch CE Short Dental Implants A Literature Review and Rationale for Use Dent Today 2005 Aug24(8)64-6 68
On the other hand a retrospective report by Misch et al was compiled
from 2 private offices using a square thread implant body design
(BioHorizons) rather than a v-shaped thread as primarily reported in the
previous literature
During a 3-year period 126 patients received implants less than 10 mm
long
Of the 437 implants there were 3 implant failures in the posterior
mandible and 1 failure in the posterior maxilla (99 survival)
All these failures were implants 9 mm long and 4 mm in diameter
Advances in Implant materials
Previously implants had macro-irregularities like macroscopic
threads fenestrations pores grooves steps threads or other
surface irregularities that were visible
However difficulty in achieving initial stability post implantation
relative motion adverse interfacial bone remodelling all lead to
search for improvement of the surface quality of a titanium dental
implant
BLASTING
Blasting -aluminium oxide titanium oxide and calcium phosphate
with particle size ranging from small medium to large (150- 350
microm)
Blasting a smooth Ti surface with Al2 O3 particles of 25 microm 75 microm
or 250 microm produces surfaces with roughness values of 116 to 120
143 and 194 to 220 respectively
A series of investigations have demonstrated a firmer bone
fixation of the implant with an average surface roughness (sa) of 1-
15microm than those of smoother implants with an average surface
roughness of 06microm
Blasting and Acid Etching
Acid etching can be done by using an HCL H2 SO4 mixture or by
pickling in 2 HF10HNO3 These processes leave pits and craters
Alumina or TiO2 for blasting the surface
Small - 25μm
large grit -025-05mm
medium grit - 250-500μm
Sand blasted and acid etched surfaces have a hydrophobic surface
The etching leads to the formation of Titanium hydrides and the
replacement of hydride by oxygen results in the slow transformation of
the implant surface resulting in nanometre sized particles of titanium on
the surface which helps in protein adhesion on implant surface
Dual acid etching with HCl and H2SO4 heated above 100ᴼC has
produced surface topography able to attach to fibrin scaffold and
promote adhesion of osteogenic cells
Sand blasting and etching can increase the rate and amount of the
bone formation
Flouride Surface Treatments
This treatment enhances osseointegration and osteoblastic
differentitation with increased expression of Cbfa1 osterix and
bone sialoprotein
Fluoridated rough implants also withstood greater push-out
forces and showed a significantly higher removal torque than
control implants
However detrimental effect of F on the corrosion resistance of
titanium and titanium alloys has been extensively reported
Anodized Surface Implants
Anodized surface implants are implants which are placed as anodes
in galvanic cells with phosphoric acid as the electrolyte and current is
passed through them ndash also ca ldquoTiunite surfacerdquo
The surface oxides grow from the native state of 5nm to
approximately 10000nm
The sa of TiUnite is reported to be 11microm and its sdr 37
Anodic oxidation results in the growth of a native titanium oxide
layer and a porous topography with the bone formation occurring
directly on the moderately rough oxidized surface
Clinical and Radiographic Evaluation of Braringnemark Implants with an
Anodized Surface following Seven-to-Eight Years of Functional Loading
David Gelb Bradley McaAllister et al Int J Dent 2013 2013 583567
The aim of this study was to evaluate the clinical and
radiographic long-term outcomes of dental implants with an
anodized TiUnite surface placed in routine clinical practice
38 single prosthesis
22 FPDs
80 implants in maxilla
27 in mandible
Mean marginal bone level change-149 plusmn 103 mm
907 of cases- no visible plaque93 -visible plaque
No prosthetic complication
Calandriello evaluated immediately placed anodized
implants in 33 patients and found a mean marginal bone
loss of 117thinspmm after 5 years
Friberg and Jemt compared 280 TiUnite implants to 110
machined implants in 111 patients and found marginal
bone loss after 5 years to be 075 and 06thinspmm respectively
with no significant difference between the two types of
implants
Laser etching and Micro Arc Oxidation
After the implants are ultrasonically cleaned they are laser etched
by using an NdYAG laser at a power of 50kw frequency of 75khz
and 164A current
They are then processed in an electrolyte solution with 35
glyceroposphate disodium salt pentahydrate and 12 calcium
acetate monohydrate by microarc oxidation (voltage 350v
frequency 800hz) for 15 seconds
Microarc oxidation produces a titania film with a porous structure
and micropores of 1-5microm
The mechanism of osseointegration of the oxidized implants has
been shown to be mechanical interlocking and biochemical
bonding
Surface coating Ti Plasma Spray
Porous rough Ti surface have been fabricated by plasma
spraying a Ti powder form of molten droplets at high temperature
at temperature in order of 15000C at 600ms
The Ti plasma spray after solidification often provides 004 ndash 005
mm thickness
Ti A spray has been reported to increase the surface area of bone
to implant interface (as much as 600) and stimulate adhesion
osteogenesis
Advantages
Enhance attachment by increasing ionic interactions
Increased load bearing capability by 25-30
Increased tensile strength through ingrowth of bony tissues into 3D feature
Disadvantages
Cracking and scaling of coating because of stresses produced by elevated temprature processing
Risk of accumulation of abraded material in the interface zone during implantation of TPS
Hydroxyapatite coatings
Hydroxyapatite [Ca10(PO4)6OH]2 coating was brought to the
dental profession by DeGroot
HA forms a strong chemical bond with bone due to the presence
of free calcium and phosphate compounds at the implant surface
The HA coating consists of amorphous and crystalline forms with
a large density of cracks
The top 1-2 microm of the HA layer being amorphous while the rest
of the crystalline layer is hexagonally packed
Indicated Fresh extraction sites
Newly grafted sites
Advantages
1 Protection of surrounding bone against metal ion release from the
substrate
2 Reported chemical bonding between HA and living bone-intimate
contact-biointegration
3 Partial dissolution of HA makes surrounding fluid rich in calcium
and phosphate ions which trigger cellular differentiation and bone
formation
Disadvantages
Induction of impurities due to thermal decomposition during
processing- affecting long term clinical fixation
Dissolution of HA at lower pH
HA coating on the implant surface (50-70microm) by various methods
1 Plasma spraying
2 The vacuum deposition technique(ion beam sputtering radiofrequency
sputtering)
3 The sol gel and dip coating method
4 Electrolytic process
Nanotitania coatings
Nanotitania coatings were prepared by using the sol-gel
technique
Nanotitania implants had an increased feature density and a large
feature coverage area as compared to the nano-HA implants
This could present more binding sites for the protein cell
attachment and for increased bone contact
he Nanotitania implants exhibited an ordered arrangement
forming a homogenous layer on underlying topography
Biologically active drugs incorporated dental
implants
Bisphosphonates Bisphosphate-loaded implant surfaces have
been reported to improve implant osseointegration
Simvastatin
Simvastatin could induce the expression of bone morphogenetic
protein (BMP) mRNA that might promote bone formation and
increase bone mineral density
Gentamycin along with the layer of HA can be coated onto the
implant surface which may act as a local prophylactic agent along
with the systemic antibiotics in dental implant surgery
Biochemical Methods
of the Surface
Modifications
Biochemical Methods of the Surface
Modifications
Their goal is to immobilize proteins enzymes or peptides on
biomaterials for the purpose of inducing specific cell and tissue
responses
1 One approach uses cell-adhesion molecules like fibronectin
vitronectin Type I collagen osteogenin and bone sialoprotein
2 The second approach uses biomolecules with osteotropic
effects which range from mitogenicity (interleukin growth
factor-I FGF-2 platelet derived growth factor ndashBB) to the
increasing activity of the bone cells which enhances the
collagen synthesis for osteoinduction
Zirconia implants
Zirconia (Zr02) is a ceramic material used in implantology because
Biocompatibility(bio inert)
Esthetics (because its colour is similar to the teeth) and
Mechanical properties which are better than alumina
High resistance to corrosion flexion and fracture
Contact with bone and soft tissue similar to that observed in
titanium implants
It can be used to produce a entire implant or as a coating
Advantages of Zirconia Dental Implants
No dark colour of the metal showing through the gums
No corrosion of the zirconia as with titanium
No piezo-electric currents between dissimilar metal in
the mouth
It is thermally non-conductive
Greater BIC (Bone ndash Implant Contact)
20 more bone apposition than titanium implants
Zeynep Ouml zkurt Zirconia Dental Implants A Literature Review Journal of Oral Implantology Vol 37(3)2011
RTQ (removal torque testing) Gahlert et al evaluated the RTQ values of
machined zirconia implants sandblasted zirconia implants and SLA titanium
implants The mean RTQ for machined zirconia implants was 259 Ncm the
mean RTQ for zirconia rough implants was 405 Ncm and the mean RTQ for
SLA titanium implants was 1052 Ncm
Fracture strength within clinically acceptable limits
Stress analysis Kohal et al observed the stress distribution patterns of
zirconia implants (ReImplant) which were found to have low well distributed
and similar stress distribution compared with titanium implants
PEEK implants (poly etheretherketone)
These implants are available in three fundamentally different
designs
TAU Diameter -48 mm lengths 10 125 15 mm
immediate loading possible
Low density bone
THETA Similar to TAU but D1 bone
IOTA It is a 3mm diameter implant (10 and 12 mm)
used in narrow ridges
Advantages
Good strengthfracture resistance and bioinertness
Promotes human oseteoblast cell growth
Disadvantages
Faintly radiopaque ndashdifficult for post-op evaluation
Lengths and diameters range is restricted
Advances in
commercially
available implant
systems
LASER- LOK TECHNOLOGY
Unique surface characteristics
Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using
laser ablation technology
Extremely consistent microchannels that are optimally
sized to attach and organize both osteoblasts and
fibroblasts
Includes a repeating nanostructure that maximizes
surface area and enables cell pseudopodia and collagen
microfibrils to interdigitate with the Laser-Lok surface
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
bull With an appropriately designed diagnostic
template ES can be performed to develop
the patientrsquos treatment plan electronically in
3 dimensions
bullTransfer of the plan to the patient at the
time of surgery can be accomplished by
production of the computer generated
three-dimensional stereotactic surgical
templates
Recent advances in
Computed Tomography(CT)
Microtomograph
Modification of CT it is specially useful in acquiring serial sections of bone
implant interface
Multi slice helical CT
The helical CT scan takes continuous pictures of the body in a rapid spiral motion
so that there are no gaps in the pictures collected
Recent Advances
in Implant Design
Mini implants
Mini dental implants (MDIs) are small diameter dental implants
Are sometimes referred to as SDIs (small diameter implants) as
well as NDIs (narrow body implants)
Diameter 18mm to 29mm (less than 3mm)
Various lengths 10 13 15 amp 18 mmrsquos
The MDI are available with either an O-ball head for use with
removable or fixed dentures or a square head for fixed prostheses or
retrofitting a poorly adapted partial denture
The body connects the tip with the prosthetic head and can be a
parallel sided cylinder or a progressively tapered cone
A small pilot bit is used to create the opening for the implant to be
threaded into the bone
The definitive implant supported crowns are usually delivered
within 2 weeks of surgery
Advantages
Immediate loading
Can be inserted in minimal tissues without relying on grafting
techniques
Minimally invasive procedure
One-stage denture stabilization
Does not require osteotomy
Cost-effective
Can be placed with a simple technique in patients with ridge too
narrow for conventional implants
Narrow-diameter implants Are they a predictable
treatment option A literature review
Joseacute-Luis Sierra-Saacutenchez Med Oral Patol Oral Cir Bucal 2014
Jan 119 (1)e74-81
The review included
Four randomized clinical trials
Ten prospective studies
Seven retrospective studies
The follow-up periods -12 months to 12 years
Total of 1607 patients
The patient age - 13 to 87 years
2980 implants
The recorded implant survival rates were above 90 in all the
studies Six studies published a survival rate of 100 at the end of
the follow-up period
The lowest survival rate (909) corresponded to the study
published by Barter et al
58 failures (implant loss) were recorded out of a total of 2980
implants
A larger number of failures were recorded with implants measuring
le 13 mm in length
Nineteen studies measured changes in peri-implant bone height
after implant loading 0065 mm the first year to 174 mm after a
follow-up period of 10 years
Araujo published a retrospective study on 33 mm implants placed
in posterior areas and rehabilitated following an immediate loading
protocol
Implant survival rate was 955 after 9 years of follow-up
That same year Degidi et al published a study comparing delayed
and immediate loading in narrow-diameter implants placed in both
anterior and posterior zones
Survival rate was 994 after a mean follow-up of 20 months
TRANSITIONAL IMPLANTS
Diameter ranges -18 to 28 mm
Length -7mm to 14mm
Fabricated with pure titanium in a single body with treated
surface
Primary function is to absorb masticatory stress during healing
phase
They should be placed at least 15 mm from adjacent teeth and
the distance between any transitional implant and a definitive
implant must be at least 15-2 mm
The abutment head generally has a 5 degree taper which makes it
optimal for retention of cement retained prostheses
Only one drill a 15 mm or 2 mm twist drill is required for
placement of the implants
Advantages
Provisionalisation of fully and partially edentulous jaws
Undisturbed healing of bone grafts
Effective way to generate aesthetic transitional appliances
Allows evaluation of phonetics and function
Cost effective
One ndash Piece Implants
The implant is machined from a piece of titanium that
incorporates both the implant body and an integral fixed abutment
in a single component
3 diameters -35 43 and 5 mm
4 lengths -10 13 15 and 16 mm
Clinical and radiographic evaluation of one-piece implants
used for immediate function
Jack a Hahn journal of oral implantology vol 33(3)2007
The aim of the present research was to evaluate the radiographic
outcome of a 1-piece implant when used for immediate function in
an ordinary patient pool
Forty-seven NobelDirect and NobelPerfect 1-piece implants
(Nobel Biocare Goumlteborg Sweden) were placed in maxillae and
mandibles
In this study 1 of the 47 implants had to be removed resulting in a
cumulative implant survival rate of 979 throughout the follow-up
period
The mean marginal bone level relative to the reference point after
1 year of loading (078 - 160 mm) as well as after 2 and 3 years of
loading was located above the first implant thread
In this study a bone level 2 mm apical to the reference point after
1 year of loading was observed at 2 implants (6)
The 1-piece implant design enables undisturbed healing
of the peri-implant soft tissue and avoids disruption of the
soft tissue seal when placing the definitive prosthetic
restoration
Annibali et al reported a series of patients treated
consecutively for first molar replacement according to
Immediate = group 1
Early = group 2
Late = Group 3
The implant survival rate
917 for early implants
950 for immediate post-extraction implants
100 for implants placed in healed sites
Short Dental Implants
A dental implant with length of 7 mm or less (Friberg et al 2000)
Any implant under 10 mm in length referred to as a lsquolsquoshortrsquorsquo
implant (Griffin TJ Cheung WS 2004)
A device with an intra-bony length of 8 mm or less (Renouard
and Nisand 2006)
Indication
Atropic Jaw
Proximity to vital structure
Single crowns
Overdentures
Advantages
1 Bone grafting for height often unnecessary
2 Less money pain and time prior to restoration of the implant
3 Simplified bone surgery
4 Implant insertion easier
Goodacre et al in 2003 reviewed
2754 implants - lt10 mm
3015 implants - gt10 mm in length
The failure rate of implants 10 mm or less was 10 compared
to a 3 failure rate of implants longer than 10 mm
Ivanoff et al in 1999 found an 8-mm-long 5-mm-diameter
implant failed 25 of the time in the maxilla and 33 of the
time in the mandible On the other hand the 10-mm and 12-
mm implants that were 5 mm in diameter reported no
mandibular failure and a 10 failure in the maxilla
Misch CE Short Dental Implants A Literature Review and Rationale for Use Dent Today 2005 Aug24(8)64-6 68
On the other hand a retrospective report by Misch et al was compiled
from 2 private offices using a square thread implant body design
(BioHorizons) rather than a v-shaped thread as primarily reported in the
previous literature
During a 3-year period 126 patients received implants less than 10 mm
long
Of the 437 implants there were 3 implant failures in the posterior
mandible and 1 failure in the posterior maxilla (99 survival)
All these failures were implants 9 mm long and 4 mm in diameter
Advances in Implant materials
Previously implants had macro-irregularities like macroscopic
threads fenestrations pores grooves steps threads or other
surface irregularities that were visible
However difficulty in achieving initial stability post implantation
relative motion adverse interfacial bone remodelling all lead to
search for improvement of the surface quality of a titanium dental
implant
BLASTING
Blasting -aluminium oxide titanium oxide and calcium phosphate
with particle size ranging from small medium to large (150- 350
microm)
Blasting a smooth Ti surface with Al2 O3 particles of 25 microm 75 microm
or 250 microm produces surfaces with roughness values of 116 to 120
143 and 194 to 220 respectively
A series of investigations have demonstrated a firmer bone
fixation of the implant with an average surface roughness (sa) of 1-
15microm than those of smoother implants with an average surface
roughness of 06microm
Blasting and Acid Etching
Acid etching can be done by using an HCL H2 SO4 mixture or by
pickling in 2 HF10HNO3 These processes leave pits and craters
Alumina or TiO2 for blasting the surface
Small - 25μm
large grit -025-05mm
medium grit - 250-500μm
Sand blasted and acid etched surfaces have a hydrophobic surface
The etching leads to the formation of Titanium hydrides and the
replacement of hydride by oxygen results in the slow transformation of
the implant surface resulting in nanometre sized particles of titanium on
the surface which helps in protein adhesion on implant surface
Dual acid etching with HCl and H2SO4 heated above 100ᴼC has
produced surface topography able to attach to fibrin scaffold and
promote adhesion of osteogenic cells
Sand blasting and etching can increase the rate and amount of the
bone formation
Flouride Surface Treatments
This treatment enhances osseointegration and osteoblastic
differentitation with increased expression of Cbfa1 osterix and
bone sialoprotein
Fluoridated rough implants also withstood greater push-out
forces and showed a significantly higher removal torque than
control implants
However detrimental effect of F on the corrosion resistance of
titanium and titanium alloys has been extensively reported
Anodized Surface Implants
Anodized surface implants are implants which are placed as anodes
in galvanic cells with phosphoric acid as the electrolyte and current is
passed through them ndash also ca ldquoTiunite surfacerdquo
The surface oxides grow from the native state of 5nm to
approximately 10000nm
The sa of TiUnite is reported to be 11microm and its sdr 37
Anodic oxidation results in the growth of a native titanium oxide
layer and a porous topography with the bone formation occurring
directly on the moderately rough oxidized surface
Clinical and Radiographic Evaluation of Braringnemark Implants with an
Anodized Surface following Seven-to-Eight Years of Functional Loading
David Gelb Bradley McaAllister et al Int J Dent 2013 2013 583567
The aim of this study was to evaluate the clinical and
radiographic long-term outcomes of dental implants with an
anodized TiUnite surface placed in routine clinical practice
38 single prosthesis
22 FPDs
80 implants in maxilla
27 in mandible
Mean marginal bone level change-149 plusmn 103 mm
907 of cases- no visible plaque93 -visible plaque
No prosthetic complication
Calandriello evaluated immediately placed anodized
implants in 33 patients and found a mean marginal bone
loss of 117thinspmm after 5 years
Friberg and Jemt compared 280 TiUnite implants to 110
machined implants in 111 patients and found marginal
bone loss after 5 years to be 075 and 06thinspmm respectively
with no significant difference between the two types of
implants
Laser etching and Micro Arc Oxidation
After the implants are ultrasonically cleaned they are laser etched
by using an NdYAG laser at a power of 50kw frequency of 75khz
and 164A current
They are then processed in an electrolyte solution with 35
glyceroposphate disodium salt pentahydrate and 12 calcium
acetate monohydrate by microarc oxidation (voltage 350v
frequency 800hz) for 15 seconds
Microarc oxidation produces a titania film with a porous structure
and micropores of 1-5microm
The mechanism of osseointegration of the oxidized implants has
been shown to be mechanical interlocking and biochemical
bonding
Surface coating Ti Plasma Spray
Porous rough Ti surface have been fabricated by plasma
spraying a Ti powder form of molten droplets at high temperature
at temperature in order of 15000C at 600ms
The Ti plasma spray after solidification often provides 004 ndash 005
mm thickness
Ti A spray has been reported to increase the surface area of bone
to implant interface (as much as 600) and stimulate adhesion
osteogenesis
Advantages
Enhance attachment by increasing ionic interactions
Increased load bearing capability by 25-30
Increased tensile strength through ingrowth of bony tissues into 3D feature
Disadvantages
Cracking and scaling of coating because of stresses produced by elevated temprature processing
Risk of accumulation of abraded material in the interface zone during implantation of TPS
Hydroxyapatite coatings
Hydroxyapatite [Ca10(PO4)6OH]2 coating was brought to the
dental profession by DeGroot
HA forms a strong chemical bond with bone due to the presence
of free calcium and phosphate compounds at the implant surface
The HA coating consists of amorphous and crystalline forms with
a large density of cracks
The top 1-2 microm of the HA layer being amorphous while the rest
of the crystalline layer is hexagonally packed
Indicated Fresh extraction sites
Newly grafted sites
Advantages
1 Protection of surrounding bone against metal ion release from the
substrate
2 Reported chemical bonding between HA and living bone-intimate
contact-biointegration
3 Partial dissolution of HA makes surrounding fluid rich in calcium
and phosphate ions which trigger cellular differentiation and bone
formation
Disadvantages
Induction of impurities due to thermal decomposition during
processing- affecting long term clinical fixation
Dissolution of HA at lower pH
HA coating on the implant surface (50-70microm) by various methods
1 Plasma spraying
2 The vacuum deposition technique(ion beam sputtering radiofrequency
sputtering)
3 The sol gel and dip coating method
4 Electrolytic process
Nanotitania coatings
Nanotitania coatings were prepared by using the sol-gel
technique
Nanotitania implants had an increased feature density and a large
feature coverage area as compared to the nano-HA implants
This could present more binding sites for the protein cell
attachment and for increased bone contact
he Nanotitania implants exhibited an ordered arrangement
forming a homogenous layer on underlying topography
Biologically active drugs incorporated dental
implants
Bisphosphonates Bisphosphate-loaded implant surfaces have
been reported to improve implant osseointegration
Simvastatin
Simvastatin could induce the expression of bone morphogenetic
protein (BMP) mRNA that might promote bone formation and
increase bone mineral density
Gentamycin along with the layer of HA can be coated onto the
implant surface which may act as a local prophylactic agent along
with the systemic antibiotics in dental implant surgery
Biochemical Methods
of the Surface
Modifications
Biochemical Methods of the Surface
Modifications
Their goal is to immobilize proteins enzymes or peptides on
biomaterials for the purpose of inducing specific cell and tissue
responses
1 One approach uses cell-adhesion molecules like fibronectin
vitronectin Type I collagen osteogenin and bone sialoprotein
2 The second approach uses biomolecules with osteotropic
effects which range from mitogenicity (interleukin growth
factor-I FGF-2 platelet derived growth factor ndashBB) to the
increasing activity of the bone cells which enhances the
collagen synthesis for osteoinduction
Zirconia implants
Zirconia (Zr02) is a ceramic material used in implantology because
Biocompatibility(bio inert)
Esthetics (because its colour is similar to the teeth) and
Mechanical properties which are better than alumina
High resistance to corrosion flexion and fracture
Contact with bone and soft tissue similar to that observed in
titanium implants
It can be used to produce a entire implant or as a coating
Advantages of Zirconia Dental Implants
No dark colour of the metal showing through the gums
No corrosion of the zirconia as with titanium
No piezo-electric currents between dissimilar metal in
the mouth
It is thermally non-conductive
Greater BIC (Bone ndash Implant Contact)
20 more bone apposition than titanium implants
Zeynep Ouml zkurt Zirconia Dental Implants A Literature Review Journal of Oral Implantology Vol 37(3)2011
RTQ (removal torque testing) Gahlert et al evaluated the RTQ values of
machined zirconia implants sandblasted zirconia implants and SLA titanium
implants The mean RTQ for machined zirconia implants was 259 Ncm the
mean RTQ for zirconia rough implants was 405 Ncm and the mean RTQ for
SLA titanium implants was 1052 Ncm
Fracture strength within clinically acceptable limits
Stress analysis Kohal et al observed the stress distribution patterns of
zirconia implants (ReImplant) which were found to have low well distributed
and similar stress distribution compared with titanium implants
PEEK implants (poly etheretherketone)
These implants are available in three fundamentally different
designs
TAU Diameter -48 mm lengths 10 125 15 mm
immediate loading possible
Low density bone
THETA Similar to TAU but D1 bone
IOTA It is a 3mm diameter implant (10 and 12 mm)
used in narrow ridges
Advantages
Good strengthfracture resistance and bioinertness
Promotes human oseteoblast cell growth
Disadvantages
Faintly radiopaque ndashdifficult for post-op evaluation
Lengths and diameters range is restricted
Advances in
commercially
available implant
systems
LASER- LOK TECHNOLOGY
Unique surface characteristics
Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using
laser ablation technology
Extremely consistent microchannels that are optimally
sized to attach and organize both osteoblasts and
fibroblasts
Includes a repeating nanostructure that maximizes
surface area and enables cell pseudopodia and collagen
microfibrils to interdigitate with the Laser-Lok surface
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Recent advances in
Computed Tomography(CT)
Microtomograph
Modification of CT it is specially useful in acquiring serial sections of bone
implant interface
Multi slice helical CT
The helical CT scan takes continuous pictures of the body in a rapid spiral motion
so that there are no gaps in the pictures collected
Recent Advances
in Implant Design
Mini implants
Mini dental implants (MDIs) are small diameter dental implants
Are sometimes referred to as SDIs (small diameter implants) as
well as NDIs (narrow body implants)
Diameter 18mm to 29mm (less than 3mm)
Various lengths 10 13 15 amp 18 mmrsquos
The MDI are available with either an O-ball head for use with
removable or fixed dentures or a square head for fixed prostheses or
retrofitting a poorly adapted partial denture
The body connects the tip with the prosthetic head and can be a
parallel sided cylinder or a progressively tapered cone
A small pilot bit is used to create the opening for the implant to be
threaded into the bone
The definitive implant supported crowns are usually delivered
within 2 weeks of surgery
Advantages
Immediate loading
Can be inserted in minimal tissues without relying on grafting
techniques
Minimally invasive procedure
One-stage denture stabilization
Does not require osteotomy
Cost-effective
Can be placed with a simple technique in patients with ridge too
narrow for conventional implants
Narrow-diameter implants Are they a predictable
treatment option A literature review
Joseacute-Luis Sierra-Saacutenchez Med Oral Patol Oral Cir Bucal 2014
Jan 119 (1)e74-81
The review included
Four randomized clinical trials
Ten prospective studies
Seven retrospective studies
The follow-up periods -12 months to 12 years
Total of 1607 patients
The patient age - 13 to 87 years
2980 implants
The recorded implant survival rates were above 90 in all the
studies Six studies published a survival rate of 100 at the end of
the follow-up period
The lowest survival rate (909) corresponded to the study
published by Barter et al
58 failures (implant loss) were recorded out of a total of 2980
implants
A larger number of failures were recorded with implants measuring
le 13 mm in length
Nineteen studies measured changes in peri-implant bone height
after implant loading 0065 mm the first year to 174 mm after a
follow-up period of 10 years
Araujo published a retrospective study on 33 mm implants placed
in posterior areas and rehabilitated following an immediate loading
protocol
Implant survival rate was 955 after 9 years of follow-up
That same year Degidi et al published a study comparing delayed
and immediate loading in narrow-diameter implants placed in both
anterior and posterior zones
Survival rate was 994 after a mean follow-up of 20 months
TRANSITIONAL IMPLANTS
Diameter ranges -18 to 28 mm
Length -7mm to 14mm
Fabricated with pure titanium in a single body with treated
surface
Primary function is to absorb masticatory stress during healing
phase
They should be placed at least 15 mm from adjacent teeth and
the distance between any transitional implant and a definitive
implant must be at least 15-2 mm
The abutment head generally has a 5 degree taper which makes it
optimal for retention of cement retained prostheses
Only one drill a 15 mm or 2 mm twist drill is required for
placement of the implants
Advantages
Provisionalisation of fully and partially edentulous jaws
Undisturbed healing of bone grafts
Effective way to generate aesthetic transitional appliances
Allows evaluation of phonetics and function
Cost effective
One ndash Piece Implants
The implant is machined from a piece of titanium that
incorporates both the implant body and an integral fixed abutment
in a single component
3 diameters -35 43 and 5 mm
4 lengths -10 13 15 and 16 mm
Clinical and radiographic evaluation of one-piece implants
used for immediate function
Jack a Hahn journal of oral implantology vol 33(3)2007
The aim of the present research was to evaluate the radiographic
outcome of a 1-piece implant when used for immediate function in
an ordinary patient pool
Forty-seven NobelDirect and NobelPerfect 1-piece implants
(Nobel Biocare Goumlteborg Sweden) were placed in maxillae and
mandibles
In this study 1 of the 47 implants had to be removed resulting in a
cumulative implant survival rate of 979 throughout the follow-up
period
The mean marginal bone level relative to the reference point after
1 year of loading (078 - 160 mm) as well as after 2 and 3 years of
loading was located above the first implant thread
In this study a bone level 2 mm apical to the reference point after
1 year of loading was observed at 2 implants (6)
The 1-piece implant design enables undisturbed healing
of the peri-implant soft tissue and avoids disruption of the
soft tissue seal when placing the definitive prosthetic
restoration
Annibali et al reported a series of patients treated
consecutively for first molar replacement according to
Immediate = group 1
Early = group 2
Late = Group 3
The implant survival rate
917 for early implants
950 for immediate post-extraction implants
100 for implants placed in healed sites
Short Dental Implants
A dental implant with length of 7 mm or less (Friberg et al 2000)
Any implant under 10 mm in length referred to as a lsquolsquoshortrsquorsquo
implant (Griffin TJ Cheung WS 2004)
A device with an intra-bony length of 8 mm or less (Renouard
and Nisand 2006)
Indication
Atropic Jaw
Proximity to vital structure
Single crowns
Overdentures
Advantages
1 Bone grafting for height often unnecessary
2 Less money pain and time prior to restoration of the implant
3 Simplified bone surgery
4 Implant insertion easier
Goodacre et al in 2003 reviewed
2754 implants - lt10 mm
3015 implants - gt10 mm in length
The failure rate of implants 10 mm or less was 10 compared
to a 3 failure rate of implants longer than 10 mm
Ivanoff et al in 1999 found an 8-mm-long 5-mm-diameter
implant failed 25 of the time in the maxilla and 33 of the
time in the mandible On the other hand the 10-mm and 12-
mm implants that were 5 mm in diameter reported no
mandibular failure and a 10 failure in the maxilla
Misch CE Short Dental Implants A Literature Review and Rationale for Use Dent Today 2005 Aug24(8)64-6 68
On the other hand a retrospective report by Misch et al was compiled
from 2 private offices using a square thread implant body design
(BioHorizons) rather than a v-shaped thread as primarily reported in the
previous literature
During a 3-year period 126 patients received implants less than 10 mm
long
Of the 437 implants there were 3 implant failures in the posterior
mandible and 1 failure in the posterior maxilla (99 survival)
All these failures were implants 9 mm long and 4 mm in diameter
Advances in Implant materials
Previously implants had macro-irregularities like macroscopic
threads fenestrations pores grooves steps threads or other
surface irregularities that were visible
However difficulty in achieving initial stability post implantation
relative motion adverse interfacial bone remodelling all lead to
search for improvement of the surface quality of a titanium dental
implant
BLASTING
Blasting -aluminium oxide titanium oxide and calcium phosphate
with particle size ranging from small medium to large (150- 350
microm)
Blasting a smooth Ti surface with Al2 O3 particles of 25 microm 75 microm
or 250 microm produces surfaces with roughness values of 116 to 120
143 and 194 to 220 respectively
A series of investigations have demonstrated a firmer bone
fixation of the implant with an average surface roughness (sa) of 1-
15microm than those of smoother implants with an average surface
roughness of 06microm
Blasting and Acid Etching
Acid etching can be done by using an HCL H2 SO4 mixture or by
pickling in 2 HF10HNO3 These processes leave pits and craters
Alumina or TiO2 for blasting the surface
Small - 25μm
large grit -025-05mm
medium grit - 250-500μm
Sand blasted and acid etched surfaces have a hydrophobic surface
The etching leads to the formation of Titanium hydrides and the
replacement of hydride by oxygen results in the slow transformation of
the implant surface resulting in nanometre sized particles of titanium on
the surface which helps in protein adhesion on implant surface
Dual acid etching with HCl and H2SO4 heated above 100ᴼC has
produced surface topography able to attach to fibrin scaffold and
promote adhesion of osteogenic cells
Sand blasting and etching can increase the rate and amount of the
bone formation
Flouride Surface Treatments
This treatment enhances osseointegration and osteoblastic
differentitation with increased expression of Cbfa1 osterix and
bone sialoprotein
Fluoridated rough implants also withstood greater push-out
forces and showed a significantly higher removal torque than
control implants
However detrimental effect of F on the corrosion resistance of
titanium and titanium alloys has been extensively reported
Anodized Surface Implants
Anodized surface implants are implants which are placed as anodes
in galvanic cells with phosphoric acid as the electrolyte and current is
passed through them ndash also ca ldquoTiunite surfacerdquo
The surface oxides grow from the native state of 5nm to
approximately 10000nm
The sa of TiUnite is reported to be 11microm and its sdr 37
Anodic oxidation results in the growth of a native titanium oxide
layer and a porous topography with the bone formation occurring
directly on the moderately rough oxidized surface
Clinical and Radiographic Evaluation of Braringnemark Implants with an
Anodized Surface following Seven-to-Eight Years of Functional Loading
David Gelb Bradley McaAllister et al Int J Dent 2013 2013 583567
The aim of this study was to evaluate the clinical and
radiographic long-term outcomes of dental implants with an
anodized TiUnite surface placed in routine clinical practice
38 single prosthesis
22 FPDs
80 implants in maxilla
27 in mandible
Mean marginal bone level change-149 plusmn 103 mm
907 of cases- no visible plaque93 -visible plaque
No prosthetic complication
Calandriello evaluated immediately placed anodized
implants in 33 patients and found a mean marginal bone
loss of 117thinspmm after 5 years
Friberg and Jemt compared 280 TiUnite implants to 110
machined implants in 111 patients and found marginal
bone loss after 5 years to be 075 and 06thinspmm respectively
with no significant difference between the two types of
implants
Laser etching and Micro Arc Oxidation
After the implants are ultrasonically cleaned they are laser etched
by using an NdYAG laser at a power of 50kw frequency of 75khz
and 164A current
They are then processed in an electrolyte solution with 35
glyceroposphate disodium salt pentahydrate and 12 calcium
acetate monohydrate by microarc oxidation (voltage 350v
frequency 800hz) for 15 seconds
Microarc oxidation produces a titania film with a porous structure
and micropores of 1-5microm
The mechanism of osseointegration of the oxidized implants has
been shown to be mechanical interlocking and biochemical
bonding
Surface coating Ti Plasma Spray
Porous rough Ti surface have been fabricated by plasma
spraying a Ti powder form of molten droplets at high temperature
at temperature in order of 15000C at 600ms
The Ti plasma spray after solidification often provides 004 ndash 005
mm thickness
Ti A spray has been reported to increase the surface area of bone
to implant interface (as much as 600) and stimulate adhesion
osteogenesis
Advantages
Enhance attachment by increasing ionic interactions
Increased load bearing capability by 25-30
Increased tensile strength through ingrowth of bony tissues into 3D feature
Disadvantages
Cracking and scaling of coating because of stresses produced by elevated temprature processing
Risk of accumulation of abraded material in the interface zone during implantation of TPS
Hydroxyapatite coatings
Hydroxyapatite [Ca10(PO4)6OH]2 coating was brought to the
dental profession by DeGroot
HA forms a strong chemical bond with bone due to the presence
of free calcium and phosphate compounds at the implant surface
The HA coating consists of amorphous and crystalline forms with
a large density of cracks
The top 1-2 microm of the HA layer being amorphous while the rest
of the crystalline layer is hexagonally packed
Indicated Fresh extraction sites
Newly grafted sites
Advantages
1 Protection of surrounding bone against metal ion release from the
substrate
2 Reported chemical bonding between HA and living bone-intimate
contact-biointegration
3 Partial dissolution of HA makes surrounding fluid rich in calcium
and phosphate ions which trigger cellular differentiation and bone
formation
Disadvantages
Induction of impurities due to thermal decomposition during
processing- affecting long term clinical fixation
Dissolution of HA at lower pH
HA coating on the implant surface (50-70microm) by various methods
1 Plasma spraying
2 The vacuum deposition technique(ion beam sputtering radiofrequency
sputtering)
3 The sol gel and dip coating method
4 Electrolytic process
Nanotitania coatings
Nanotitania coatings were prepared by using the sol-gel
technique
Nanotitania implants had an increased feature density and a large
feature coverage area as compared to the nano-HA implants
This could present more binding sites for the protein cell
attachment and for increased bone contact
he Nanotitania implants exhibited an ordered arrangement
forming a homogenous layer on underlying topography
Biologically active drugs incorporated dental
implants
Bisphosphonates Bisphosphate-loaded implant surfaces have
been reported to improve implant osseointegration
Simvastatin
Simvastatin could induce the expression of bone morphogenetic
protein (BMP) mRNA that might promote bone formation and
increase bone mineral density
Gentamycin along with the layer of HA can be coated onto the
implant surface which may act as a local prophylactic agent along
with the systemic antibiotics in dental implant surgery
Biochemical Methods
of the Surface
Modifications
Biochemical Methods of the Surface
Modifications
Their goal is to immobilize proteins enzymes or peptides on
biomaterials for the purpose of inducing specific cell and tissue
responses
1 One approach uses cell-adhesion molecules like fibronectin
vitronectin Type I collagen osteogenin and bone sialoprotein
2 The second approach uses biomolecules with osteotropic
effects which range from mitogenicity (interleukin growth
factor-I FGF-2 platelet derived growth factor ndashBB) to the
increasing activity of the bone cells which enhances the
collagen synthesis for osteoinduction
Zirconia implants
Zirconia (Zr02) is a ceramic material used in implantology because
Biocompatibility(bio inert)
Esthetics (because its colour is similar to the teeth) and
Mechanical properties which are better than alumina
High resistance to corrosion flexion and fracture
Contact with bone and soft tissue similar to that observed in
titanium implants
It can be used to produce a entire implant or as a coating
Advantages of Zirconia Dental Implants
No dark colour of the metal showing through the gums
No corrosion of the zirconia as with titanium
No piezo-electric currents between dissimilar metal in
the mouth
It is thermally non-conductive
Greater BIC (Bone ndash Implant Contact)
20 more bone apposition than titanium implants
Zeynep Ouml zkurt Zirconia Dental Implants A Literature Review Journal of Oral Implantology Vol 37(3)2011
RTQ (removal torque testing) Gahlert et al evaluated the RTQ values of
machined zirconia implants sandblasted zirconia implants and SLA titanium
implants The mean RTQ for machined zirconia implants was 259 Ncm the
mean RTQ for zirconia rough implants was 405 Ncm and the mean RTQ for
SLA titanium implants was 1052 Ncm
Fracture strength within clinically acceptable limits
Stress analysis Kohal et al observed the stress distribution patterns of
zirconia implants (ReImplant) which were found to have low well distributed
and similar stress distribution compared with titanium implants
PEEK implants (poly etheretherketone)
These implants are available in three fundamentally different
designs
TAU Diameter -48 mm lengths 10 125 15 mm
immediate loading possible
Low density bone
THETA Similar to TAU but D1 bone
IOTA It is a 3mm diameter implant (10 and 12 mm)
used in narrow ridges
Advantages
Good strengthfracture resistance and bioinertness
Promotes human oseteoblast cell growth
Disadvantages
Faintly radiopaque ndashdifficult for post-op evaluation
Lengths and diameters range is restricted
Advances in
commercially
available implant
systems
LASER- LOK TECHNOLOGY
Unique surface characteristics
Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using
laser ablation technology
Extremely consistent microchannels that are optimally
sized to attach and organize both osteoblasts and
fibroblasts
Includes a repeating nanostructure that maximizes
surface area and enables cell pseudopodia and collagen
microfibrils to interdigitate with the Laser-Lok surface
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Recent Advances
in Implant Design
Mini implants
Mini dental implants (MDIs) are small diameter dental implants
Are sometimes referred to as SDIs (small diameter implants) as
well as NDIs (narrow body implants)
Diameter 18mm to 29mm (less than 3mm)
Various lengths 10 13 15 amp 18 mmrsquos
The MDI are available with either an O-ball head for use with
removable or fixed dentures or a square head for fixed prostheses or
retrofitting a poorly adapted partial denture
The body connects the tip with the prosthetic head and can be a
parallel sided cylinder or a progressively tapered cone
A small pilot bit is used to create the opening for the implant to be
threaded into the bone
The definitive implant supported crowns are usually delivered
within 2 weeks of surgery
Advantages
Immediate loading
Can be inserted in minimal tissues without relying on grafting
techniques
Minimally invasive procedure
One-stage denture stabilization
Does not require osteotomy
Cost-effective
Can be placed with a simple technique in patients with ridge too
narrow for conventional implants
Narrow-diameter implants Are they a predictable
treatment option A literature review
Joseacute-Luis Sierra-Saacutenchez Med Oral Patol Oral Cir Bucal 2014
Jan 119 (1)e74-81
The review included
Four randomized clinical trials
Ten prospective studies
Seven retrospective studies
The follow-up periods -12 months to 12 years
Total of 1607 patients
The patient age - 13 to 87 years
2980 implants
The recorded implant survival rates were above 90 in all the
studies Six studies published a survival rate of 100 at the end of
the follow-up period
The lowest survival rate (909) corresponded to the study
published by Barter et al
58 failures (implant loss) were recorded out of a total of 2980
implants
A larger number of failures were recorded with implants measuring
le 13 mm in length
Nineteen studies measured changes in peri-implant bone height
after implant loading 0065 mm the first year to 174 mm after a
follow-up period of 10 years
Araujo published a retrospective study on 33 mm implants placed
in posterior areas and rehabilitated following an immediate loading
protocol
Implant survival rate was 955 after 9 years of follow-up
That same year Degidi et al published a study comparing delayed
and immediate loading in narrow-diameter implants placed in both
anterior and posterior zones
Survival rate was 994 after a mean follow-up of 20 months
TRANSITIONAL IMPLANTS
Diameter ranges -18 to 28 mm
Length -7mm to 14mm
Fabricated with pure titanium in a single body with treated
surface
Primary function is to absorb masticatory stress during healing
phase
They should be placed at least 15 mm from adjacent teeth and
the distance between any transitional implant and a definitive
implant must be at least 15-2 mm
The abutment head generally has a 5 degree taper which makes it
optimal for retention of cement retained prostheses
Only one drill a 15 mm or 2 mm twist drill is required for
placement of the implants
Advantages
Provisionalisation of fully and partially edentulous jaws
Undisturbed healing of bone grafts
Effective way to generate aesthetic transitional appliances
Allows evaluation of phonetics and function
Cost effective
One ndash Piece Implants
The implant is machined from a piece of titanium that
incorporates both the implant body and an integral fixed abutment
in a single component
3 diameters -35 43 and 5 mm
4 lengths -10 13 15 and 16 mm
Clinical and radiographic evaluation of one-piece implants
used for immediate function
Jack a Hahn journal of oral implantology vol 33(3)2007
The aim of the present research was to evaluate the radiographic
outcome of a 1-piece implant when used for immediate function in
an ordinary patient pool
Forty-seven NobelDirect and NobelPerfect 1-piece implants
(Nobel Biocare Goumlteborg Sweden) were placed in maxillae and
mandibles
In this study 1 of the 47 implants had to be removed resulting in a
cumulative implant survival rate of 979 throughout the follow-up
period
The mean marginal bone level relative to the reference point after
1 year of loading (078 - 160 mm) as well as after 2 and 3 years of
loading was located above the first implant thread
In this study a bone level 2 mm apical to the reference point after
1 year of loading was observed at 2 implants (6)
The 1-piece implant design enables undisturbed healing
of the peri-implant soft tissue and avoids disruption of the
soft tissue seal when placing the definitive prosthetic
restoration
Annibali et al reported a series of patients treated
consecutively for first molar replacement according to
Immediate = group 1
Early = group 2
Late = Group 3
The implant survival rate
917 for early implants
950 for immediate post-extraction implants
100 for implants placed in healed sites
Short Dental Implants
A dental implant with length of 7 mm or less (Friberg et al 2000)
Any implant under 10 mm in length referred to as a lsquolsquoshortrsquorsquo
implant (Griffin TJ Cheung WS 2004)
A device with an intra-bony length of 8 mm or less (Renouard
and Nisand 2006)
Indication
Atropic Jaw
Proximity to vital structure
Single crowns
Overdentures
Advantages
1 Bone grafting for height often unnecessary
2 Less money pain and time prior to restoration of the implant
3 Simplified bone surgery
4 Implant insertion easier
Goodacre et al in 2003 reviewed
2754 implants - lt10 mm
3015 implants - gt10 mm in length
The failure rate of implants 10 mm or less was 10 compared
to a 3 failure rate of implants longer than 10 mm
Ivanoff et al in 1999 found an 8-mm-long 5-mm-diameter
implant failed 25 of the time in the maxilla and 33 of the
time in the mandible On the other hand the 10-mm and 12-
mm implants that were 5 mm in diameter reported no
mandibular failure and a 10 failure in the maxilla
Misch CE Short Dental Implants A Literature Review and Rationale for Use Dent Today 2005 Aug24(8)64-6 68
On the other hand a retrospective report by Misch et al was compiled
from 2 private offices using a square thread implant body design
(BioHorizons) rather than a v-shaped thread as primarily reported in the
previous literature
During a 3-year period 126 patients received implants less than 10 mm
long
Of the 437 implants there were 3 implant failures in the posterior
mandible and 1 failure in the posterior maxilla (99 survival)
All these failures were implants 9 mm long and 4 mm in diameter
Advances in Implant materials
Previously implants had macro-irregularities like macroscopic
threads fenestrations pores grooves steps threads or other
surface irregularities that were visible
However difficulty in achieving initial stability post implantation
relative motion adverse interfacial bone remodelling all lead to
search for improvement of the surface quality of a titanium dental
implant
BLASTING
Blasting -aluminium oxide titanium oxide and calcium phosphate
with particle size ranging from small medium to large (150- 350
microm)
Blasting a smooth Ti surface with Al2 O3 particles of 25 microm 75 microm
or 250 microm produces surfaces with roughness values of 116 to 120
143 and 194 to 220 respectively
A series of investigations have demonstrated a firmer bone
fixation of the implant with an average surface roughness (sa) of 1-
15microm than those of smoother implants with an average surface
roughness of 06microm
Blasting and Acid Etching
Acid etching can be done by using an HCL H2 SO4 mixture or by
pickling in 2 HF10HNO3 These processes leave pits and craters
Alumina or TiO2 for blasting the surface
Small - 25μm
large grit -025-05mm
medium grit - 250-500μm
Sand blasted and acid etched surfaces have a hydrophobic surface
The etching leads to the formation of Titanium hydrides and the
replacement of hydride by oxygen results in the slow transformation of
the implant surface resulting in nanometre sized particles of titanium on
the surface which helps in protein adhesion on implant surface
Dual acid etching with HCl and H2SO4 heated above 100ᴼC has
produced surface topography able to attach to fibrin scaffold and
promote adhesion of osteogenic cells
Sand blasting and etching can increase the rate and amount of the
bone formation
Flouride Surface Treatments
This treatment enhances osseointegration and osteoblastic
differentitation with increased expression of Cbfa1 osterix and
bone sialoprotein
Fluoridated rough implants also withstood greater push-out
forces and showed a significantly higher removal torque than
control implants
However detrimental effect of F on the corrosion resistance of
titanium and titanium alloys has been extensively reported
Anodized Surface Implants
Anodized surface implants are implants which are placed as anodes
in galvanic cells with phosphoric acid as the electrolyte and current is
passed through them ndash also ca ldquoTiunite surfacerdquo
The surface oxides grow from the native state of 5nm to
approximately 10000nm
The sa of TiUnite is reported to be 11microm and its sdr 37
Anodic oxidation results in the growth of a native titanium oxide
layer and a porous topography with the bone formation occurring
directly on the moderately rough oxidized surface
Clinical and Radiographic Evaluation of Braringnemark Implants with an
Anodized Surface following Seven-to-Eight Years of Functional Loading
David Gelb Bradley McaAllister et al Int J Dent 2013 2013 583567
The aim of this study was to evaluate the clinical and
radiographic long-term outcomes of dental implants with an
anodized TiUnite surface placed in routine clinical practice
38 single prosthesis
22 FPDs
80 implants in maxilla
27 in mandible
Mean marginal bone level change-149 plusmn 103 mm
907 of cases- no visible plaque93 -visible plaque
No prosthetic complication
Calandriello evaluated immediately placed anodized
implants in 33 patients and found a mean marginal bone
loss of 117thinspmm after 5 years
Friberg and Jemt compared 280 TiUnite implants to 110
machined implants in 111 patients and found marginal
bone loss after 5 years to be 075 and 06thinspmm respectively
with no significant difference between the two types of
implants
Laser etching and Micro Arc Oxidation
After the implants are ultrasonically cleaned they are laser etched
by using an NdYAG laser at a power of 50kw frequency of 75khz
and 164A current
They are then processed in an electrolyte solution with 35
glyceroposphate disodium salt pentahydrate and 12 calcium
acetate monohydrate by microarc oxidation (voltage 350v
frequency 800hz) for 15 seconds
Microarc oxidation produces a titania film with a porous structure
and micropores of 1-5microm
The mechanism of osseointegration of the oxidized implants has
been shown to be mechanical interlocking and biochemical
bonding
Surface coating Ti Plasma Spray
Porous rough Ti surface have been fabricated by plasma
spraying a Ti powder form of molten droplets at high temperature
at temperature in order of 15000C at 600ms
The Ti plasma spray after solidification often provides 004 ndash 005
mm thickness
Ti A spray has been reported to increase the surface area of bone
to implant interface (as much as 600) and stimulate adhesion
osteogenesis
Advantages
Enhance attachment by increasing ionic interactions
Increased load bearing capability by 25-30
Increased tensile strength through ingrowth of bony tissues into 3D feature
Disadvantages
Cracking and scaling of coating because of stresses produced by elevated temprature processing
Risk of accumulation of abraded material in the interface zone during implantation of TPS
Hydroxyapatite coatings
Hydroxyapatite [Ca10(PO4)6OH]2 coating was brought to the
dental profession by DeGroot
HA forms a strong chemical bond with bone due to the presence
of free calcium and phosphate compounds at the implant surface
The HA coating consists of amorphous and crystalline forms with
a large density of cracks
The top 1-2 microm of the HA layer being amorphous while the rest
of the crystalline layer is hexagonally packed
Indicated Fresh extraction sites
Newly grafted sites
Advantages
1 Protection of surrounding bone against metal ion release from the
substrate
2 Reported chemical bonding between HA and living bone-intimate
contact-biointegration
3 Partial dissolution of HA makes surrounding fluid rich in calcium
and phosphate ions which trigger cellular differentiation and bone
formation
Disadvantages
Induction of impurities due to thermal decomposition during
processing- affecting long term clinical fixation
Dissolution of HA at lower pH
HA coating on the implant surface (50-70microm) by various methods
1 Plasma spraying
2 The vacuum deposition technique(ion beam sputtering radiofrequency
sputtering)
3 The sol gel and dip coating method
4 Electrolytic process
Nanotitania coatings
Nanotitania coatings were prepared by using the sol-gel
technique
Nanotitania implants had an increased feature density and a large
feature coverage area as compared to the nano-HA implants
This could present more binding sites for the protein cell
attachment and for increased bone contact
he Nanotitania implants exhibited an ordered arrangement
forming a homogenous layer on underlying topography
Biologically active drugs incorporated dental
implants
Bisphosphonates Bisphosphate-loaded implant surfaces have
been reported to improve implant osseointegration
Simvastatin
Simvastatin could induce the expression of bone morphogenetic
protein (BMP) mRNA that might promote bone formation and
increase bone mineral density
Gentamycin along with the layer of HA can be coated onto the
implant surface which may act as a local prophylactic agent along
with the systemic antibiotics in dental implant surgery
Biochemical Methods
of the Surface
Modifications
Biochemical Methods of the Surface
Modifications
Their goal is to immobilize proteins enzymes or peptides on
biomaterials for the purpose of inducing specific cell and tissue
responses
1 One approach uses cell-adhesion molecules like fibronectin
vitronectin Type I collagen osteogenin and bone sialoprotein
2 The second approach uses biomolecules with osteotropic
effects which range from mitogenicity (interleukin growth
factor-I FGF-2 platelet derived growth factor ndashBB) to the
increasing activity of the bone cells which enhances the
collagen synthesis for osteoinduction
Zirconia implants
Zirconia (Zr02) is a ceramic material used in implantology because
Biocompatibility(bio inert)
Esthetics (because its colour is similar to the teeth) and
Mechanical properties which are better than alumina
High resistance to corrosion flexion and fracture
Contact with bone and soft tissue similar to that observed in
titanium implants
It can be used to produce a entire implant or as a coating
Advantages of Zirconia Dental Implants
No dark colour of the metal showing through the gums
No corrosion of the zirconia as with titanium
No piezo-electric currents between dissimilar metal in
the mouth
It is thermally non-conductive
Greater BIC (Bone ndash Implant Contact)
20 more bone apposition than titanium implants
Zeynep Ouml zkurt Zirconia Dental Implants A Literature Review Journal of Oral Implantology Vol 37(3)2011
RTQ (removal torque testing) Gahlert et al evaluated the RTQ values of
machined zirconia implants sandblasted zirconia implants and SLA titanium
implants The mean RTQ for machined zirconia implants was 259 Ncm the
mean RTQ for zirconia rough implants was 405 Ncm and the mean RTQ for
SLA titanium implants was 1052 Ncm
Fracture strength within clinically acceptable limits
Stress analysis Kohal et al observed the stress distribution patterns of
zirconia implants (ReImplant) which were found to have low well distributed
and similar stress distribution compared with titanium implants
PEEK implants (poly etheretherketone)
These implants are available in three fundamentally different
designs
TAU Diameter -48 mm lengths 10 125 15 mm
immediate loading possible
Low density bone
THETA Similar to TAU but D1 bone
IOTA It is a 3mm diameter implant (10 and 12 mm)
used in narrow ridges
Advantages
Good strengthfracture resistance and bioinertness
Promotes human oseteoblast cell growth
Disadvantages
Faintly radiopaque ndashdifficult for post-op evaluation
Lengths and diameters range is restricted
Advances in
commercially
available implant
systems
LASER- LOK TECHNOLOGY
Unique surface characteristics
Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using
laser ablation technology
Extremely consistent microchannels that are optimally
sized to attach and organize both osteoblasts and
fibroblasts
Includes a repeating nanostructure that maximizes
surface area and enables cell pseudopodia and collagen
microfibrils to interdigitate with the Laser-Lok surface
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Mini implants
Mini dental implants (MDIs) are small diameter dental implants
Are sometimes referred to as SDIs (small diameter implants) as
well as NDIs (narrow body implants)
Diameter 18mm to 29mm (less than 3mm)
Various lengths 10 13 15 amp 18 mmrsquos
The MDI are available with either an O-ball head for use with
removable or fixed dentures or a square head for fixed prostheses or
retrofitting a poorly adapted partial denture
The body connects the tip with the prosthetic head and can be a
parallel sided cylinder or a progressively tapered cone
A small pilot bit is used to create the opening for the implant to be
threaded into the bone
The definitive implant supported crowns are usually delivered
within 2 weeks of surgery
Advantages
Immediate loading
Can be inserted in minimal tissues without relying on grafting
techniques
Minimally invasive procedure
One-stage denture stabilization
Does not require osteotomy
Cost-effective
Can be placed with a simple technique in patients with ridge too
narrow for conventional implants
Narrow-diameter implants Are they a predictable
treatment option A literature review
Joseacute-Luis Sierra-Saacutenchez Med Oral Patol Oral Cir Bucal 2014
Jan 119 (1)e74-81
The review included
Four randomized clinical trials
Ten prospective studies
Seven retrospective studies
The follow-up periods -12 months to 12 years
Total of 1607 patients
The patient age - 13 to 87 years
2980 implants
The recorded implant survival rates were above 90 in all the
studies Six studies published a survival rate of 100 at the end of
the follow-up period
The lowest survival rate (909) corresponded to the study
published by Barter et al
58 failures (implant loss) were recorded out of a total of 2980
implants
A larger number of failures were recorded with implants measuring
le 13 mm in length
Nineteen studies measured changes in peri-implant bone height
after implant loading 0065 mm the first year to 174 mm after a
follow-up period of 10 years
Araujo published a retrospective study on 33 mm implants placed
in posterior areas and rehabilitated following an immediate loading
protocol
Implant survival rate was 955 after 9 years of follow-up
That same year Degidi et al published a study comparing delayed
and immediate loading in narrow-diameter implants placed in both
anterior and posterior zones
Survival rate was 994 after a mean follow-up of 20 months
TRANSITIONAL IMPLANTS
Diameter ranges -18 to 28 mm
Length -7mm to 14mm
Fabricated with pure titanium in a single body with treated
surface
Primary function is to absorb masticatory stress during healing
phase
They should be placed at least 15 mm from adjacent teeth and
the distance between any transitional implant and a definitive
implant must be at least 15-2 mm
The abutment head generally has a 5 degree taper which makes it
optimal for retention of cement retained prostheses
Only one drill a 15 mm or 2 mm twist drill is required for
placement of the implants
Advantages
Provisionalisation of fully and partially edentulous jaws
Undisturbed healing of bone grafts
Effective way to generate aesthetic transitional appliances
Allows evaluation of phonetics and function
Cost effective
One ndash Piece Implants
The implant is machined from a piece of titanium that
incorporates both the implant body and an integral fixed abutment
in a single component
3 diameters -35 43 and 5 mm
4 lengths -10 13 15 and 16 mm
Clinical and radiographic evaluation of one-piece implants
used for immediate function
Jack a Hahn journal of oral implantology vol 33(3)2007
The aim of the present research was to evaluate the radiographic
outcome of a 1-piece implant when used for immediate function in
an ordinary patient pool
Forty-seven NobelDirect and NobelPerfect 1-piece implants
(Nobel Biocare Goumlteborg Sweden) were placed in maxillae and
mandibles
In this study 1 of the 47 implants had to be removed resulting in a
cumulative implant survival rate of 979 throughout the follow-up
period
The mean marginal bone level relative to the reference point after
1 year of loading (078 - 160 mm) as well as after 2 and 3 years of
loading was located above the first implant thread
In this study a bone level 2 mm apical to the reference point after
1 year of loading was observed at 2 implants (6)
The 1-piece implant design enables undisturbed healing
of the peri-implant soft tissue and avoids disruption of the
soft tissue seal when placing the definitive prosthetic
restoration
Annibali et al reported a series of patients treated
consecutively for first molar replacement according to
Immediate = group 1
Early = group 2
Late = Group 3
The implant survival rate
917 for early implants
950 for immediate post-extraction implants
100 for implants placed in healed sites
Short Dental Implants
A dental implant with length of 7 mm or less (Friberg et al 2000)
Any implant under 10 mm in length referred to as a lsquolsquoshortrsquorsquo
implant (Griffin TJ Cheung WS 2004)
A device with an intra-bony length of 8 mm or less (Renouard
and Nisand 2006)
Indication
Atropic Jaw
Proximity to vital structure
Single crowns
Overdentures
Advantages
1 Bone grafting for height often unnecessary
2 Less money pain and time prior to restoration of the implant
3 Simplified bone surgery
4 Implant insertion easier
Goodacre et al in 2003 reviewed
2754 implants - lt10 mm
3015 implants - gt10 mm in length
The failure rate of implants 10 mm or less was 10 compared
to a 3 failure rate of implants longer than 10 mm
Ivanoff et al in 1999 found an 8-mm-long 5-mm-diameter
implant failed 25 of the time in the maxilla and 33 of the
time in the mandible On the other hand the 10-mm and 12-
mm implants that were 5 mm in diameter reported no
mandibular failure and a 10 failure in the maxilla
Misch CE Short Dental Implants A Literature Review and Rationale for Use Dent Today 2005 Aug24(8)64-6 68
On the other hand a retrospective report by Misch et al was compiled
from 2 private offices using a square thread implant body design
(BioHorizons) rather than a v-shaped thread as primarily reported in the
previous literature
During a 3-year period 126 patients received implants less than 10 mm
long
Of the 437 implants there were 3 implant failures in the posterior
mandible and 1 failure in the posterior maxilla (99 survival)
All these failures were implants 9 mm long and 4 mm in diameter
Advances in Implant materials
Previously implants had macro-irregularities like macroscopic
threads fenestrations pores grooves steps threads or other
surface irregularities that were visible
However difficulty in achieving initial stability post implantation
relative motion adverse interfacial bone remodelling all lead to
search for improvement of the surface quality of a titanium dental
implant
BLASTING
Blasting -aluminium oxide titanium oxide and calcium phosphate
with particle size ranging from small medium to large (150- 350
microm)
Blasting a smooth Ti surface with Al2 O3 particles of 25 microm 75 microm
or 250 microm produces surfaces with roughness values of 116 to 120
143 and 194 to 220 respectively
A series of investigations have demonstrated a firmer bone
fixation of the implant with an average surface roughness (sa) of 1-
15microm than those of smoother implants with an average surface
roughness of 06microm
Blasting and Acid Etching
Acid etching can be done by using an HCL H2 SO4 mixture or by
pickling in 2 HF10HNO3 These processes leave pits and craters
Alumina or TiO2 for blasting the surface
Small - 25μm
large grit -025-05mm
medium grit - 250-500μm
Sand blasted and acid etched surfaces have a hydrophobic surface
The etching leads to the formation of Titanium hydrides and the
replacement of hydride by oxygen results in the slow transformation of
the implant surface resulting in nanometre sized particles of titanium on
the surface which helps in protein adhesion on implant surface
Dual acid etching with HCl and H2SO4 heated above 100ᴼC has
produced surface topography able to attach to fibrin scaffold and
promote adhesion of osteogenic cells
Sand blasting and etching can increase the rate and amount of the
bone formation
Flouride Surface Treatments
This treatment enhances osseointegration and osteoblastic
differentitation with increased expression of Cbfa1 osterix and
bone sialoprotein
Fluoridated rough implants also withstood greater push-out
forces and showed a significantly higher removal torque than
control implants
However detrimental effect of F on the corrosion resistance of
titanium and titanium alloys has been extensively reported
Anodized Surface Implants
Anodized surface implants are implants which are placed as anodes
in galvanic cells with phosphoric acid as the electrolyte and current is
passed through them ndash also ca ldquoTiunite surfacerdquo
The surface oxides grow from the native state of 5nm to
approximately 10000nm
The sa of TiUnite is reported to be 11microm and its sdr 37
Anodic oxidation results in the growth of a native titanium oxide
layer and a porous topography with the bone formation occurring
directly on the moderately rough oxidized surface
Clinical and Radiographic Evaluation of Braringnemark Implants with an
Anodized Surface following Seven-to-Eight Years of Functional Loading
David Gelb Bradley McaAllister et al Int J Dent 2013 2013 583567
The aim of this study was to evaluate the clinical and
radiographic long-term outcomes of dental implants with an
anodized TiUnite surface placed in routine clinical practice
38 single prosthesis
22 FPDs
80 implants in maxilla
27 in mandible
Mean marginal bone level change-149 plusmn 103 mm
907 of cases- no visible plaque93 -visible plaque
No prosthetic complication
Calandriello evaluated immediately placed anodized
implants in 33 patients and found a mean marginal bone
loss of 117thinspmm after 5 years
Friberg and Jemt compared 280 TiUnite implants to 110
machined implants in 111 patients and found marginal
bone loss after 5 years to be 075 and 06thinspmm respectively
with no significant difference between the two types of
implants
Laser etching and Micro Arc Oxidation
After the implants are ultrasonically cleaned they are laser etched
by using an NdYAG laser at a power of 50kw frequency of 75khz
and 164A current
They are then processed in an electrolyte solution with 35
glyceroposphate disodium salt pentahydrate and 12 calcium
acetate monohydrate by microarc oxidation (voltage 350v
frequency 800hz) for 15 seconds
Microarc oxidation produces a titania film with a porous structure
and micropores of 1-5microm
The mechanism of osseointegration of the oxidized implants has
been shown to be mechanical interlocking and biochemical
bonding
Surface coating Ti Plasma Spray
Porous rough Ti surface have been fabricated by plasma
spraying a Ti powder form of molten droplets at high temperature
at temperature in order of 15000C at 600ms
The Ti plasma spray after solidification often provides 004 ndash 005
mm thickness
Ti A spray has been reported to increase the surface area of bone
to implant interface (as much as 600) and stimulate adhesion
osteogenesis
Advantages
Enhance attachment by increasing ionic interactions
Increased load bearing capability by 25-30
Increased tensile strength through ingrowth of bony tissues into 3D feature
Disadvantages
Cracking and scaling of coating because of stresses produced by elevated temprature processing
Risk of accumulation of abraded material in the interface zone during implantation of TPS
Hydroxyapatite coatings
Hydroxyapatite [Ca10(PO4)6OH]2 coating was brought to the
dental profession by DeGroot
HA forms a strong chemical bond with bone due to the presence
of free calcium and phosphate compounds at the implant surface
The HA coating consists of amorphous and crystalline forms with
a large density of cracks
The top 1-2 microm of the HA layer being amorphous while the rest
of the crystalline layer is hexagonally packed
Indicated Fresh extraction sites
Newly grafted sites
Advantages
1 Protection of surrounding bone against metal ion release from the
substrate
2 Reported chemical bonding between HA and living bone-intimate
contact-biointegration
3 Partial dissolution of HA makes surrounding fluid rich in calcium
and phosphate ions which trigger cellular differentiation and bone
formation
Disadvantages
Induction of impurities due to thermal decomposition during
processing- affecting long term clinical fixation
Dissolution of HA at lower pH
HA coating on the implant surface (50-70microm) by various methods
1 Plasma spraying
2 The vacuum deposition technique(ion beam sputtering radiofrequency
sputtering)
3 The sol gel and dip coating method
4 Electrolytic process
Nanotitania coatings
Nanotitania coatings were prepared by using the sol-gel
technique
Nanotitania implants had an increased feature density and a large
feature coverage area as compared to the nano-HA implants
This could present more binding sites for the protein cell
attachment and for increased bone contact
he Nanotitania implants exhibited an ordered arrangement
forming a homogenous layer on underlying topography
Biologically active drugs incorporated dental
implants
Bisphosphonates Bisphosphate-loaded implant surfaces have
been reported to improve implant osseointegration
Simvastatin
Simvastatin could induce the expression of bone morphogenetic
protein (BMP) mRNA that might promote bone formation and
increase bone mineral density
Gentamycin along with the layer of HA can be coated onto the
implant surface which may act as a local prophylactic agent along
with the systemic antibiotics in dental implant surgery
Biochemical Methods
of the Surface
Modifications
Biochemical Methods of the Surface
Modifications
Their goal is to immobilize proteins enzymes or peptides on
biomaterials for the purpose of inducing specific cell and tissue
responses
1 One approach uses cell-adhesion molecules like fibronectin
vitronectin Type I collagen osteogenin and bone sialoprotein
2 The second approach uses biomolecules with osteotropic
effects which range from mitogenicity (interleukin growth
factor-I FGF-2 platelet derived growth factor ndashBB) to the
increasing activity of the bone cells which enhances the
collagen synthesis for osteoinduction
Zirconia implants
Zirconia (Zr02) is a ceramic material used in implantology because
Biocompatibility(bio inert)
Esthetics (because its colour is similar to the teeth) and
Mechanical properties which are better than alumina
High resistance to corrosion flexion and fracture
Contact with bone and soft tissue similar to that observed in
titanium implants
It can be used to produce a entire implant or as a coating
Advantages of Zirconia Dental Implants
No dark colour of the metal showing through the gums
No corrosion of the zirconia as with titanium
No piezo-electric currents between dissimilar metal in
the mouth
It is thermally non-conductive
Greater BIC (Bone ndash Implant Contact)
20 more bone apposition than titanium implants
Zeynep Ouml zkurt Zirconia Dental Implants A Literature Review Journal of Oral Implantology Vol 37(3)2011
RTQ (removal torque testing) Gahlert et al evaluated the RTQ values of
machined zirconia implants sandblasted zirconia implants and SLA titanium
implants The mean RTQ for machined zirconia implants was 259 Ncm the
mean RTQ for zirconia rough implants was 405 Ncm and the mean RTQ for
SLA titanium implants was 1052 Ncm
Fracture strength within clinically acceptable limits
Stress analysis Kohal et al observed the stress distribution patterns of
zirconia implants (ReImplant) which were found to have low well distributed
and similar stress distribution compared with titanium implants
PEEK implants (poly etheretherketone)
These implants are available in three fundamentally different
designs
TAU Diameter -48 mm lengths 10 125 15 mm
immediate loading possible
Low density bone
THETA Similar to TAU but D1 bone
IOTA It is a 3mm diameter implant (10 and 12 mm)
used in narrow ridges
Advantages
Good strengthfracture resistance and bioinertness
Promotes human oseteoblast cell growth
Disadvantages
Faintly radiopaque ndashdifficult for post-op evaluation
Lengths and diameters range is restricted
Advances in
commercially
available implant
systems
LASER- LOK TECHNOLOGY
Unique surface characteristics
Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using
laser ablation technology
Extremely consistent microchannels that are optimally
sized to attach and organize both osteoblasts and
fibroblasts
Includes a repeating nanostructure that maximizes
surface area and enables cell pseudopodia and collagen
microfibrils to interdigitate with the Laser-Lok surface
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
The MDI are available with either an O-ball head for use with
removable or fixed dentures or a square head for fixed prostheses or
retrofitting a poorly adapted partial denture
The body connects the tip with the prosthetic head and can be a
parallel sided cylinder or a progressively tapered cone
A small pilot bit is used to create the opening for the implant to be
threaded into the bone
The definitive implant supported crowns are usually delivered
within 2 weeks of surgery
Advantages
Immediate loading
Can be inserted in minimal tissues without relying on grafting
techniques
Minimally invasive procedure
One-stage denture stabilization
Does not require osteotomy
Cost-effective
Can be placed with a simple technique in patients with ridge too
narrow for conventional implants
Narrow-diameter implants Are they a predictable
treatment option A literature review
Joseacute-Luis Sierra-Saacutenchez Med Oral Patol Oral Cir Bucal 2014
Jan 119 (1)e74-81
The review included
Four randomized clinical trials
Ten prospective studies
Seven retrospective studies
The follow-up periods -12 months to 12 years
Total of 1607 patients
The patient age - 13 to 87 years
2980 implants
The recorded implant survival rates were above 90 in all the
studies Six studies published a survival rate of 100 at the end of
the follow-up period
The lowest survival rate (909) corresponded to the study
published by Barter et al
58 failures (implant loss) were recorded out of a total of 2980
implants
A larger number of failures were recorded with implants measuring
le 13 mm in length
Nineteen studies measured changes in peri-implant bone height
after implant loading 0065 mm the first year to 174 mm after a
follow-up period of 10 years
Araujo published a retrospective study on 33 mm implants placed
in posterior areas and rehabilitated following an immediate loading
protocol
Implant survival rate was 955 after 9 years of follow-up
That same year Degidi et al published a study comparing delayed
and immediate loading in narrow-diameter implants placed in both
anterior and posterior zones
Survival rate was 994 after a mean follow-up of 20 months
TRANSITIONAL IMPLANTS
Diameter ranges -18 to 28 mm
Length -7mm to 14mm
Fabricated with pure titanium in a single body with treated
surface
Primary function is to absorb masticatory stress during healing
phase
They should be placed at least 15 mm from adjacent teeth and
the distance between any transitional implant and a definitive
implant must be at least 15-2 mm
The abutment head generally has a 5 degree taper which makes it
optimal for retention of cement retained prostheses
Only one drill a 15 mm or 2 mm twist drill is required for
placement of the implants
Advantages
Provisionalisation of fully and partially edentulous jaws
Undisturbed healing of bone grafts
Effective way to generate aesthetic transitional appliances
Allows evaluation of phonetics and function
Cost effective
One ndash Piece Implants
The implant is machined from a piece of titanium that
incorporates both the implant body and an integral fixed abutment
in a single component
3 diameters -35 43 and 5 mm
4 lengths -10 13 15 and 16 mm
Clinical and radiographic evaluation of one-piece implants
used for immediate function
Jack a Hahn journal of oral implantology vol 33(3)2007
The aim of the present research was to evaluate the radiographic
outcome of a 1-piece implant when used for immediate function in
an ordinary patient pool
Forty-seven NobelDirect and NobelPerfect 1-piece implants
(Nobel Biocare Goumlteborg Sweden) were placed in maxillae and
mandibles
In this study 1 of the 47 implants had to be removed resulting in a
cumulative implant survival rate of 979 throughout the follow-up
period
The mean marginal bone level relative to the reference point after
1 year of loading (078 - 160 mm) as well as after 2 and 3 years of
loading was located above the first implant thread
In this study a bone level 2 mm apical to the reference point after
1 year of loading was observed at 2 implants (6)
The 1-piece implant design enables undisturbed healing
of the peri-implant soft tissue and avoids disruption of the
soft tissue seal when placing the definitive prosthetic
restoration
Annibali et al reported a series of patients treated
consecutively for first molar replacement according to
Immediate = group 1
Early = group 2
Late = Group 3
The implant survival rate
917 for early implants
950 for immediate post-extraction implants
100 for implants placed in healed sites
Short Dental Implants
A dental implant with length of 7 mm or less (Friberg et al 2000)
Any implant under 10 mm in length referred to as a lsquolsquoshortrsquorsquo
implant (Griffin TJ Cheung WS 2004)
A device with an intra-bony length of 8 mm or less (Renouard
and Nisand 2006)
Indication
Atropic Jaw
Proximity to vital structure
Single crowns
Overdentures
Advantages
1 Bone grafting for height often unnecessary
2 Less money pain and time prior to restoration of the implant
3 Simplified bone surgery
4 Implant insertion easier
Goodacre et al in 2003 reviewed
2754 implants - lt10 mm
3015 implants - gt10 mm in length
The failure rate of implants 10 mm or less was 10 compared
to a 3 failure rate of implants longer than 10 mm
Ivanoff et al in 1999 found an 8-mm-long 5-mm-diameter
implant failed 25 of the time in the maxilla and 33 of the
time in the mandible On the other hand the 10-mm and 12-
mm implants that were 5 mm in diameter reported no
mandibular failure and a 10 failure in the maxilla
Misch CE Short Dental Implants A Literature Review and Rationale for Use Dent Today 2005 Aug24(8)64-6 68
On the other hand a retrospective report by Misch et al was compiled
from 2 private offices using a square thread implant body design
(BioHorizons) rather than a v-shaped thread as primarily reported in the
previous literature
During a 3-year period 126 patients received implants less than 10 mm
long
Of the 437 implants there were 3 implant failures in the posterior
mandible and 1 failure in the posterior maxilla (99 survival)
All these failures were implants 9 mm long and 4 mm in diameter
Advances in Implant materials
Previously implants had macro-irregularities like macroscopic
threads fenestrations pores grooves steps threads or other
surface irregularities that were visible
However difficulty in achieving initial stability post implantation
relative motion adverse interfacial bone remodelling all lead to
search for improvement of the surface quality of a titanium dental
implant
BLASTING
Blasting -aluminium oxide titanium oxide and calcium phosphate
with particle size ranging from small medium to large (150- 350
microm)
Blasting a smooth Ti surface with Al2 O3 particles of 25 microm 75 microm
or 250 microm produces surfaces with roughness values of 116 to 120
143 and 194 to 220 respectively
A series of investigations have demonstrated a firmer bone
fixation of the implant with an average surface roughness (sa) of 1-
15microm than those of smoother implants with an average surface
roughness of 06microm
Blasting and Acid Etching
Acid etching can be done by using an HCL H2 SO4 mixture or by
pickling in 2 HF10HNO3 These processes leave pits and craters
Alumina or TiO2 for blasting the surface
Small - 25μm
large grit -025-05mm
medium grit - 250-500μm
Sand blasted and acid etched surfaces have a hydrophobic surface
The etching leads to the formation of Titanium hydrides and the
replacement of hydride by oxygen results in the slow transformation of
the implant surface resulting in nanometre sized particles of titanium on
the surface which helps in protein adhesion on implant surface
Dual acid etching with HCl and H2SO4 heated above 100ᴼC has
produced surface topography able to attach to fibrin scaffold and
promote adhesion of osteogenic cells
Sand blasting and etching can increase the rate and amount of the
bone formation
Flouride Surface Treatments
This treatment enhances osseointegration and osteoblastic
differentitation with increased expression of Cbfa1 osterix and
bone sialoprotein
Fluoridated rough implants also withstood greater push-out
forces and showed a significantly higher removal torque than
control implants
However detrimental effect of F on the corrosion resistance of
titanium and titanium alloys has been extensively reported
Anodized Surface Implants
Anodized surface implants are implants which are placed as anodes
in galvanic cells with phosphoric acid as the electrolyte and current is
passed through them ndash also ca ldquoTiunite surfacerdquo
The surface oxides grow from the native state of 5nm to
approximately 10000nm
The sa of TiUnite is reported to be 11microm and its sdr 37
Anodic oxidation results in the growth of a native titanium oxide
layer and a porous topography with the bone formation occurring
directly on the moderately rough oxidized surface
Clinical and Radiographic Evaluation of Braringnemark Implants with an
Anodized Surface following Seven-to-Eight Years of Functional Loading
David Gelb Bradley McaAllister et al Int J Dent 2013 2013 583567
The aim of this study was to evaluate the clinical and
radiographic long-term outcomes of dental implants with an
anodized TiUnite surface placed in routine clinical practice
38 single prosthesis
22 FPDs
80 implants in maxilla
27 in mandible
Mean marginal bone level change-149 plusmn 103 mm
907 of cases- no visible plaque93 -visible plaque
No prosthetic complication
Calandriello evaluated immediately placed anodized
implants in 33 patients and found a mean marginal bone
loss of 117thinspmm after 5 years
Friberg and Jemt compared 280 TiUnite implants to 110
machined implants in 111 patients and found marginal
bone loss after 5 years to be 075 and 06thinspmm respectively
with no significant difference between the two types of
implants
Laser etching and Micro Arc Oxidation
After the implants are ultrasonically cleaned they are laser etched
by using an NdYAG laser at a power of 50kw frequency of 75khz
and 164A current
They are then processed in an electrolyte solution with 35
glyceroposphate disodium salt pentahydrate and 12 calcium
acetate monohydrate by microarc oxidation (voltage 350v
frequency 800hz) for 15 seconds
Microarc oxidation produces a titania film with a porous structure
and micropores of 1-5microm
The mechanism of osseointegration of the oxidized implants has
been shown to be mechanical interlocking and biochemical
bonding
Surface coating Ti Plasma Spray
Porous rough Ti surface have been fabricated by plasma
spraying a Ti powder form of molten droplets at high temperature
at temperature in order of 15000C at 600ms
The Ti plasma spray after solidification often provides 004 ndash 005
mm thickness
Ti A spray has been reported to increase the surface area of bone
to implant interface (as much as 600) and stimulate adhesion
osteogenesis
Advantages
Enhance attachment by increasing ionic interactions
Increased load bearing capability by 25-30
Increased tensile strength through ingrowth of bony tissues into 3D feature
Disadvantages
Cracking and scaling of coating because of stresses produced by elevated temprature processing
Risk of accumulation of abraded material in the interface zone during implantation of TPS
Hydroxyapatite coatings
Hydroxyapatite [Ca10(PO4)6OH]2 coating was brought to the
dental profession by DeGroot
HA forms a strong chemical bond with bone due to the presence
of free calcium and phosphate compounds at the implant surface
The HA coating consists of amorphous and crystalline forms with
a large density of cracks
The top 1-2 microm of the HA layer being amorphous while the rest
of the crystalline layer is hexagonally packed
Indicated Fresh extraction sites
Newly grafted sites
Advantages
1 Protection of surrounding bone against metal ion release from the
substrate
2 Reported chemical bonding between HA and living bone-intimate
contact-biointegration
3 Partial dissolution of HA makes surrounding fluid rich in calcium
and phosphate ions which trigger cellular differentiation and bone
formation
Disadvantages
Induction of impurities due to thermal decomposition during
processing- affecting long term clinical fixation
Dissolution of HA at lower pH
HA coating on the implant surface (50-70microm) by various methods
1 Plasma spraying
2 The vacuum deposition technique(ion beam sputtering radiofrequency
sputtering)
3 The sol gel and dip coating method
4 Electrolytic process
Nanotitania coatings
Nanotitania coatings were prepared by using the sol-gel
technique
Nanotitania implants had an increased feature density and a large
feature coverage area as compared to the nano-HA implants
This could present more binding sites for the protein cell
attachment and for increased bone contact
he Nanotitania implants exhibited an ordered arrangement
forming a homogenous layer on underlying topography
Biologically active drugs incorporated dental
implants
Bisphosphonates Bisphosphate-loaded implant surfaces have
been reported to improve implant osseointegration
Simvastatin
Simvastatin could induce the expression of bone morphogenetic
protein (BMP) mRNA that might promote bone formation and
increase bone mineral density
Gentamycin along with the layer of HA can be coated onto the
implant surface which may act as a local prophylactic agent along
with the systemic antibiotics in dental implant surgery
Biochemical Methods
of the Surface
Modifications
Biochemical Methods of the Surface
Modifications
Their goal is to immobilize proteins enzymes or peptides on
biomaterials for the purpose of inducing specific cell and tissue
responses
1 One approach uses cell-adhesion molecules like fibronectin
vitronectin Type I collagen osteogenin and bone sialoprotein
2 The second approach uses biomolecules with osteotropic
effects which range from mitogenicity (interleukin growth
factor-I FGF-2 platelet derived growth factor ndashBB) to the
increasing activity of the bone cells which enhances the
collagen synthesis for osteoinduction
Zirconia implants
Zirconia (Zr02) is a ceramic material used in implantology because
Biocompatibility(bio inert)
Esthetics (because its colour is similar to the teeth) and
Mechanical properties which are better than alumina
High resistance to corrosion flexion and fracture
Contact with bone and soft tissue similar to that observed in
titanium implants
It can be used to produce a entire implant or as a coating
Advantages of Zirconia Dental Implants
No dark colour of the metal showing through the gums
No corrosion of the zirconia as with titanium
No piezo-electric currents between dissimilar metal in
the mouth
It is thermally non-conductive
Greater BIC (Bone ndash Implant Contact)
20 more bone apposition than titanium implants
Zeynep Ouml zkurt Zirconia Dental Implants A Literature Review Journal of Oral Implantology Vol 37(3)2011
RTQ (removal torque testing) Gahlert et al evaluated the RTQ values of
machined zirconia implants sandblasted zirconia implants and SLA titanium
implants The mean RTQ for machined zirconia implants was 259 Ncm the
mean RTQ for zirconia rough implants was 405 Ncm and the mean RTQ for
SLA titanium implants was 1052 Ncm
Fracture strength within clinically acceptable limits
Stress analysis Kohal et al observed the stress distribution patterns of
zirconia implants (ReImplant) which were found to have low well distributed
and similar stress distribution compared with titanium implants
PEEK implants (poly etheretherketone)
These implants are available in three fundamentally different
designs
TAU Diameter -48 mm lengths 10 125 15 mm
immediate loading possible
Low density bone
THETA Similar to TAU but D1 bone
IOTA It is a 3mm diameter implant (10 and 12 mm)
used in narrow ridges
Advantages
Good strengthfracture resistance and bioinertness
Promotes human oseteoblast cell growth
Disadvantages
Faintly radiopaque ndashdifficult for post-op evaluation
Lengths and diameters range is restricted
Advances in
commercially
available implant
systems
LASER- LOK TECHNOLOGY
Unique surface characteristics
Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using
laser ablation technology
Extremely consistent microchannels that are optimally
sized to attach and organize both osteoblasts and
fibroblasts
Includes a repeating nanostructure that maximizes
surface area and enables cell pseudopodia and collagen
microfibrils to interdigitate with the Laser-Lok surface
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Advantages
Immediate loading
Can be inserted in minimal tissues without relying on grafting
techniques
Minimally invasive procedure
One-stage denture stabilization
Does not require osteotomy
Cost-effective
Can be placed with a simple technique in patients with ridge too
narrow for conventional implants
Narrow-diameter implants Are they a predictable
treatment option A literature review
Joseacute-Luis Sierra-Saacutenchez Med Oral Patol Oral Cir Bucal 2014
Jan 119 (1)e74-81
The review included
Four randomized clinical trials
Ten prospective studies
Seven retrospective studies
The follow-up periods -12 months to 12 years
Total of 1607 patients
The patient age - 13 to 87 years
2980 implants
The recorded implant survival rates were above 90 in all the
studies Six studies published a survival rate of 100 at the end of
the follow-up period
The lowest survival rate (909) corresponded to the study
published by Barter et al
58 failures (implant loss) were recorded out of a total of 2980
implants
A larger number of failures were recorded with implants measuring
le 13 mm in length
Nineteen studies measured changes in peri-implant bone height
after implant loading 0065 mm the first year to 174 mm after a
follow-up period of 10 years
Araujo published a retrospective study on 33 mm implants placed
in posterior areas and rehabilitated following an immediate loading
protocol
Implant survival rate was 955 after 9 years of follow-up
That same year Degidi et al published a study comparing delayed
and immediate loading in narrow-diameter implants placed in both
anterior and posterior zones
Survival rate was 994 after a mean follow-up of 20 months
TRANSITIONAL IMPLANTS
Diameter ranges -18 to 28 mm
Length -7mm to 14mm
Fabricated with pure titanium in a single body with treated
surface
Primary function is to absorb masticatory stress during healing
phase
They should be placed at least 15 mm from adjacent teeth and
the distance between any transitional implant and a definitive
implant must be at least 15-2 mm
The abutment head generally has a 5 degree taper which makes it
optimal for retention of cement retained prostheses
Only one drill a 15 mm or 2 mm twist drill is required for
placement of the implants
Advantages
Provisionalisation of fully and partially edentulous jaws
Undisturbed healing of bone grafts
Effective way to generate aesthetic transitional appliances
Allows evaluation of phonetics and function
Cost effective
One ndash Piece Implants
The implant is machined from a piece of titanium that
incorporates both the implant body and an integral fixed abutment
in a single component
3 diameters -35 43 and 5 mm
4 lengths -10 13 15 and 16 mm
Clinical and radiographic evaluation of one-piece implants
used for immediate function
Jack a Hahn journal of oral implantology vol 33(3)2007
The aim of the present research was to evaluate the radiographic
outcome of a 1-piece implant when used for immediate function in
an ordinary patient pool
Forty-seven NobelDirect and NobelPerfect 1-piece implants
(Nobel Biocare Goumlteborg Sweden) were placed in maxillae and
mandibles
In this study 1 of the 47 implants had to be removed resulting in a
cumulative implant survival rate of 979 throughout the follow-up
period
The mean marginal bone level relative to the reference point after
1 year of loading (078 - 160 mm) as well as after 2 and 3 years of
loading was located above the first implant thread
In this study a bone level 2 mm apical to the reference point after
1 year of loading was observed at 2 implants (6)
The 1-piece implant design enables undisturbed healing
of the peri-implant soft tissue and avoids disruption of the
soft tissue seal when placing the definitive prosthetic
restoration
Annibali et al reported a series of patients treated
consecutively for first molar replacement according to
Immediate = group 1
Early = group 2
Late = Group 3
The implant survival rate
917 for early implants
950 for immediate post-extraction implants
100 for implants placed in healed sites
Short Dental Implants
A dental implant with length of 7 mm or less (Friberg et al 2000)
Any implant under 10 mm in length referred to as a lsquolsquoshortrsquorsquo
implant (Griffin TJ Cheung WS 2004)
A device with an intra-bony length of 8 mm or less (Renouard
and Nisand 2006)
Indication
Atropic Jaw
Proximity to vital structure
Single crowns
Overdentures
Advantages
1 Bone grafting for height often unnecessary
2 Less money pain and time prior to restoration of the implant
3 Simplified bone surgery
4 Implant insertion easier
Goodacre et al in 2003 reviewed
2754 implants - lt10 mm
3015 implants - gt10 mm in length
The failure rate of implants 10 mm or less was 10 compared
to a 3 failure rate of implants longer than 10 mm
Ivanoff et al in 1999 found an 8-mm-long 5-mm-diameter
implant failed 25 of the time in the maxilla and 33 of the
time in the mandible On the other hand the 10-mm and 12-
mm implants that were 5 mm in diameter reported no
mandibular failure and a 10 failure in the maxilla
Misch CE Short Dental Implants A Literature Review and Rationale for Use Dent Today 2005 Aug24(8)64-6 68
On the other hand a retrospective report by Misch et al was compiled
from 2 private offices using a square thread implant body design
(BioHorizons) rather than a v-shaped thread as primarily reported in the
previous literature
During a 3-year period 126 patients received implants less than 10 mm
long
Of the 437 implants there were 3 implant failures in the posterior
mandible and 1 failure in the posterior maxilla (99 survival)
All these failures were implants 9 mm long and 4 mm in diameter
Advances in Implant materials
Previously implants had macro-irregularities like macroscopic
threads fenestrations pores grooves steps threads or other
surface irregularities that were visible
However difficulty in achieving initial stability post implantation
relative motion adverse interfacial bone remodelling all lead to
search for improvement of the surface quality of a titanium dental
implant
BLASTING
Blasting -aluminium oxide titanium oxide and calcium phosphate
with particle size ranging from small medium to large (150- 350
microm)
Blasting a smooth Ti surface with Al2 O3 particles of 25 microm 75 microm
or 250 microm produces surfaces with roughness values of 116 to 120
143 and 194 to 220 respectively
A series of investigations have demonstrated a firmer bone
fixation of the implant with an average surface roughness (sa) of 1-
15microm than those of smoother implants with an average surface
roughness of 06microm
Blasting and Acid Etching
Acid etching can be done by using an HCL H2 SO4 mixture or by
pickling in 2 HF10HNO3 These processes leave pits and craters
Alumina or TiO2 for blasting the surface
Small - 25μm
large grit -025-05mm
medium grit - 250-500μm
Sand blasted and acid etched surfaces have a hydrophobic surface
The etching leads to the formation of Titanium hydrides and the
replacement of hydride by oxygen results in the slow transformation of
the implant surface resulting in nanometre sized particles of titanium on
the surface which helps in protein adhesion on implant surface
Dual acid etching with HCl and H2SO4 heated above 100ᴼC has
produced surface topography able to attach to fibrin scaffold and
promote adhesion of osteogenic cells
Sand blasting and etching can increase the rate and amount of the
bone formation
Flouride Surface Treatments
This treatment enhances osseointegration and osteoblastic
differentitation with increased expression of Cbfa1 osterix and
bone sialoprotein
Fluoridated rough implants also withstood greater push-out
forces and showed a significantly higher removal torque than
control implants
However detrimental effect of F on the corrosion resistance of
titanium and titanium alloys has been extensively reported
Anodized Surface Implants
Anodized surface implants are implants which are placed as anodes
in galvanic cells with phosphoric acid as the electrolyte and current is
passed through them ndash also ca ldquoTiunite surfacerdquo
The surface oxides grow from the native state of 5nm to
approximately 10000nm
The sa of TiUnite is reported to be 11microm and its sdr 37
Anodic oxidation results in the growth of a native titanium oxide
layer and a porous topography with the bone formation occurring
directly on the moderately rough oxidized surface
Clinical and Radiographic Evaluation of Braringnemark Implants with an
Anodized Surface following Seven-to-Eight Years of Functional Loading
David Gelb Bradley McaAllister et al Int J Dent 2013 2013 583567
The aim of this study was to evaluate the clinical and
radiographic long-term outcomes of dental implants with an
anodized TiUnite surface placed in routine clinical practice
38 single prosthesis
22 FPDs
80 implants in maxilla
27 in mandible
Mean marginal bone level change-149 plusmn 103 mm
907 of cases- no visible plaque93 -visible plaque
No prosthetic complication
Calandriello evaluated immediately placed anodized
implants in 33 patients and found a mean marginal bone
loss of 117thinspmm after 5 years
Friberg and Jemt compared 280 TiUnite implants to 110
machined implants in 111 patients and found marginal
bone loss after 5 years to be 075 and 06thinspmm respectively
with no significant difference between the two types of
implants
Laser etching and Micro Arc Oxidation
After the implants are ultrasonically cleaned they are laser etched
by using an NdYAG laser at a power of 50kw frequency of 75khz
and 164A current
They are then processed in an electrolyte solution with 35
glyceroposphate disodium salt pentahydrate and 12 calcium
acetate monohydrate by microarc oxidation (voltage 350v
frequency 800hz) for 15 seconds
Microarc oxidation produces a titania film with a porous structure
and micropores of 1-5microm
The mechanism of osseointegration of the oxidized implants has
been shown to be mechanical interlocking and biochemical
bonding
Surface coating Ti Plasma Spray
Porous rough Ti surface have been fabricated by plasma
spraying a Ti powder form of molten droplets at high temperature
at temperature in order of 15000C at 600ms
The Ti plasma spray after solidification often provides 004 ndash 005
mm thickness
Ti A spray has been reported to increase the surface area of bone
to implant interface (as much as 600) and stimulate adhesion
osteogenesis
Advantages
Enhance attachment by increasing ionic interactions
Increased load bearing capability by 25-30
Increased tensile strength through ingrowth of bony tissues into 3D feature
Disadvantages
Cracking and scaling of coating because of stresses produced by elevated temprature processing
Risk of accumulation of abraded material in the interface zone during implantation of TPS
Hydroxyapatite coatings
Hydroxyapatite [Ca10(PO4)6OH]2 coating was brought to the
dental profession by DeGroot
HA forms a strong chemical bond with bone due to the presence
of free calcium and phosphate compounds at the implant surface
The HA coating consists of amorphous and crystalline forms with
a large density of cracks
The top 1-2 microm of the HA layer being amorphous while the rest
of the crystalline layer is hexagonally packed
Indicated Fresh extraction sites
Newly grafted sites
Advantages
1 Protection of surrounding bone against metal ion release from the
substrate
2 Reported chemical bonding between HA and living bone-intimate
contact-biointegration
3 Partial dissolution of HA makes surrounding fluid rich in calcium
and phosphate ions which trigger cellular differentiation and bone
formation
Disadvantages
Induction of impurities due to thermal decomposition during
processing- affecting long term clinical fixation
Dissolution of HA at lower pH
HA coating on the implant surface (50-70microm) by various methods
1 Plasma spraying
2 The vacuum deposition technique(ion beam sputtering radiofrequency
sputtering)
3 The sol gel and dip coating method
4 Electrolytic process
Nanotitania coatings
Nanotitania coatings were prepared by using the sol-gel
technique
Nanotitania implants had an increased feature density and a large
feature coverage area as compared to the nano-HA implants
This could present more binding sites for the protein cell
attachment and for increased bone contact
he Nanotitania implants exhibited an ordered arrangement
forming a homogenous layer on underlying topography
Biologically active drugs incorporated dental
implants
Bisphosphonates Bisphosphate-loaded implant surfaces have
been reported to improve implant osseointegration
Simvastatin
Simvastatin could induce the expression of bone morphogenetic
protein (BMP) mRNA that might promote bone formation and
increase bone mineral density
Gentamycin along with the layer of HA can be coated onto the
implant surface which may act as a local prophylactic agent along
with the systemic antibiotics in dental implant surgery
Biochemical Methods
of the Surface
Modifications
Biochemical Methods of the Surface
Modifications
Their goal is to immobilize proteins enzymes or peptides on
biomaterials for the purpose of inducing specific cell and tissue
responses
1 One approach uses cell-adhesion molecules like fibronectin
vitronectin Type I collagen osteogenin and bone sialoprotein
2 The second approach uses biomolecules with osteotropic
effects which range from mitogenicity (interleukin growth
factor-I FGF-2 platelet derived growth factor ndashBB) to the
increasing activity of the bone cells which enhances the
collagen synthesis for osteoinduction
Zirconia implants
Zirconia (Zr02) is a ceramic material used in implantology because
Biocompatibility(bio inert)
Esthetics (because its colour is similar to the teeth) and
Mechanical properties which are better than alumina
High resistance to corrosion flexion and fracture
Contact with bone and soft tissue similar to that observed in
titanium implants
It can be used to produce a entire implant or as a coating
Advantages of Zirconia Dental Implants
No dark colour of the metal showing through the gums
No corrosion of the zirconia as with titanium
No piezo-electric currents between dissimilar metal in
the mouth
It is thermally non-conductive
Greater BIC (Bone ndash Implant Contact)
20 more bone apposition than titanium implants
Zeynep Ouml zkurt Zirconia Dental Implants A Literature Review Journal of Oral Implantology Vol 37(3)2011
RTQ (removal torque testing) Gahlert et al evaluated the RTQ values of
machined zirconia implants sandblasted zirconia implants and SLA titanium
implants The mean RTQ for machined zirconia implants was 259 Ncm the
mean RTQ for zirconia rough implants was 405 Ncm and the mean RTQ for
SLA titanium implants was 1052 Ncm
Fracture strength within clinically acceptable limits
Stress analysis Kohal et al observed the stress distribution patterns of
zirconia implants (ReImplant) which were found to have low well distributed
and similar stress distribution compared with titanium implants
PEEK implants (poly etheretherketone)
These implants are available in three fundamentally different
designs
TAU Diameter -48 mm lengths 10 125 15 mm
immediate loading possible
Low density bone
THETA Similar to TAU but D1 bone
IOTA It is a 3mm diameter implant (10 and 12 mm)
used in narrow ridges
Advantages
Good strengthfracture resistance and bioinertness
Promotes human oseteoblast cell growth
Disadvantages
Faintly radiopaque ndashdifficult for post-op evaluation
Lengths and diameters range is restricted
Advances in
commercially
available implant
systems
LASER- LOK TECHNOLOGY
Unique surface characteristics
Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using
laser ablation technology
Extremely consistent microchannels that are optimally
sized to attach and organize both osteoblasts and
fibroblasts
Includes a repeating nanostructure that maximizes
surface area and enables cell pseudopodia and collagen
microfibrils to interdigitate with the Laser-Lok surface
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Narrow-diameter implants Are they a predictable
treatment option A literature review
Joseacute-Luis Sierra-Saacutenchez Med Oral Patol Oral Cir Bucal 2014
Jan 119 (1)e74-81
The review included
Four randomized clinical trials
Ten prospective studies
Seven retrospective studies
The follow-up periods -12 months to 12 years
Total of 1607 patients
The patient age - 13 to 87 years
2980 implants
The recorded implant survival rates were above 90 in all the
studies Six studies published a survival rate of 100 at the end of
the follow-up period
The lowest survival rate (909) corresponded to the study
published by Barter et al
58 failures (implant loss) were recorded out of a total of 2980
implants
A larger number of failures were recorded with implants measuring
le 13 mm in length
Nineteen studies measured changes in peri-implant bone height
after implant loading 0065 mm the first year to 174 mm after a
follow-up period of 10 years
Araujo published a retrospective study on 33 mm implants placed
in posterior areas and rehabilitated following an immediate loading
protocol
Implant survival rate was 955 after 9 years of follow-up
That same year Degidi et al published a study comparing delayed
and immediate loading in narrow-diameter implants placed in both
anterior and posterior zones
Survival rate was 994 after a mean follow-up of 20 months
TRANSITIONAL IMPLANTS
Diameter ranges -18 to 28 mm
Length -7mm to 14mm
Fabricated with pure titanium in a single body with treated
surface
Primary function is to absorb masticatory stress during healing
phase
They should be placed at least 15 mm from adjacent teeth and
the distance between any transitional implant and a definitive
implant must be at least 15-2 mm
The abutment head generally has a 5 degree taper which makes it
optimal for retention of cement retained prostheses
Only one drill a 15 mm or 2 mm twist drill is required for
placement of the implants
Advantages
Provisionalisation of fully and partially edentulous jaws
Undisturbed healing of bone grafts
Effective way to generate aesthetic transitional appliances
Allows evaluation of phonetics and function
Cost effective
One ndash Piece Implants
The implant is machined from a piece of titanium that
incorporates both the implant body and an integral fixed abutment
in a single component
3 diameters -35 43 and 5 mm
4 lengths -10 13 15 and 16 mm
Clinical and radiographic evaluation of one-piece implants
used for immediate function
Jack a Hahn journal of oral implantology vol 33(3)2007
The aim of the present research was to evaluate the radiographic
outcome of a 1-piece implant when used for immediate function in
an ordinary patient pool
Forty-seven NobelDirect and NobelPerfect 1-piece implants
(Nobel Biocare Goumlteborg Sweden) were placed in maxillae and
mandibles
In this study 1 of the 47 implants had to be removed resulting in a
cumulative implant survival rate of 979 throughout the follow-up
period
The mean marginal bone level relative to the reference point after
1 year of loading (078 - 160 mm) as well as after 2 and 3 years of
loading was located above the first implant thread
In this study a bone level 2 mm apical to the reference point after
1 year of loading was observed at 2 implants (6)
The 1-piece implant design enables undisturbed healing
of the peri-implant soft tissue and avoids disruption of the
soft tissue seal when placing the definitive prosthetic
restoration
Annibali et al reported a series of patients treated
consecutively for first molar replacement according to
Immediate = group 1
Early = group 2
Late = Group 3
The implant survival rate
917 for early implants
950 for immediate post-extraction implants
100 for implants placed in healed sites
Short Dental Implants
A dental implant with length of 7 mm or less (Friberg et al 2000)
Any implant under 10 mm in length referred to as a lsquolsquoshortrsquorsquo
implant (Griffin TJ Cheung WS 2004)
A device with an intra-bony length of 8 mm or less (Renouard
and Nisand 2006)
Indication
Atropic Jaw
Proximity to vital structure
Single crowns
Overdentures
Advantages
1 Bone grafting for height often unnecessary
2 Less money pain and time prior to restoration of the implant
3 Simplified bone surgery
4 Implant insertion easier
Goodacre et al in 2003 reviewed
2754 implants - lt10 mm
3015 implants - gt10 mm in length
The failure rate of implants 10 mm or less was 10 compared
to a 3 failure rate of implants longer than 10 mm
Ivanoff et al in 1999 found an 8-mm-long 5-mm-diameter
implant failed 25 of the time in the maxilla and 33 of the
time in the mandible On the other hand the 10-mm and 12-
mm implants that were 5 mm in diameter reported no
mandibular failure and a 10 failure in the maxilla
Misch CE Short Dental Implants A Literature Review and Rationale for Use Dent Today 2005 Aug24(8)64-6 68
On the other hand a retrospective report by Misch et al was compiled
from 2 private offices using a square thread implant body design
(BioHorizons) rather than a v-shaped thread as primarily reported in the
previous literature
During a 3-year period 126 patients received implants less than 10 mm
long
Of the 437 implants there were 3 implant failures in the posterior
mandible and 1 failure in the posterior maxilla (99 survival)
All these failures were implants 9 mm long and 4 mm in diameter
Advances in Implant materials
Previously implants had macro-irregularities like macroscopic
threads fenestrations pores grooves steps threads or other
surface irregularities that were visible
However difficulty in achieving initial stability post implantation
relative motion adverse interfacial bone remodelling all lead to
search for improvement of the surface quality of a titanium dental
implant
BLASTING
Blasting -aluminium oxide titanium oxide and calcium phosphate
with particle size ranging from small medium to large (150- 350
microm)
Blasting a smooth Ti surface with Al2 O3 particles of 25 microm 75 microm
or 250 microm produces surfaces with roughness values of 116 to 120
143 and 194 to 220 respectively
A series of investigations have demonstrated a firmer bone
fixation of the implant with an average surface roughness (sa) of 1-
15microm than those of smoother implants with an average surface
roughness of 06microm
Blasting and Acid Etching
Acid etching can be done by using an HCL H2 SO4 mixture or by
pickling in 2 HF10HNO3 These processes leave pits and craters
Alumina or TiO2 for blasting the surface
Small - 25μm
large grit -025-05mm
medium grit - 250-500μm
Sand blasted and acid etched surfaces have a hydrophobic surface
The etching leads to the formation of Titanium hydrides and the
replacement of hydride by oxygen results in the slow transformation of
the implant surface resulting in nanometre sized particles of titanium on
the surface which helps in protein adhesion on implant surface
Dual acid etching with HCl and H2SO4 heated above 100ᴼC has
produced surface topography able to attach to fibrin scaffold and
promote adhesion of osteogenic cells
Sand blasting and etching can increase the rate and amount of the
bone formation
Flouride Surface Treatments
This treatment enhances osseointegration and osteoblastic
differentitation with increased expression of Cbfa1 osterix and
bone sialoprotein
Fluoridated rough implants also withstood greater push-out
forces and showed a significantly higher removal torque than
control implants
However detrimental effect of F on the corrosion resistance of
titanium and titanium alloys has been extensively reported
Anodized Surface Implants
Anodized surface implants are implants which are placed as anodes
in galvanic cells with phosphoric acid as the electrolyte and current is
passed through them ndash also ca ldquoTiunite surfacerdquo
The surface oxides grow from the native state of 5nm to
approximately 10000nm
The sa of TiUnite is reported to be 11microm and its sdr 37
Anodic oxidation results in the growth of a native titanium oxide
layer and a porous topography with the bone formation occurring
directly on the moderately rough oxidized surface
Clinical and Radiographic Evaluation of Braringnemark Implants with an
Anodized Surface following Seven-to-Eight Years of Functional Loading
David Gelb Bradley McaAllister et al Int J Dent 2013 2013 583567
The aim of this study was to evaluate the clinical and
radiographic long-term outcomes of dental implants with an
anodized TiUnite surface placed in routine clinical practice
38 single prosthesis
22 FPDs
80 implants in maxilla
27 in mandible
Mean marginal bone level change-149 plusmn 103 mm
907 of cases- no visible plaque93 -visible plaque
No prosthetic complication
Calandriello evaluated immediately placed anodized
implants in 33 patients and found a mean marginal bone
loss of 117thinspmm after 5 years
Friberg and Jemt compared 280 TiUnite implants to 110
machined implants in 111 patients and found marginal
bone loss after 5 years to be 075 and 06thinspmm respectively
with no significant difference between the two types of
implants
Laser etching and Micro Arc Oxidation
After the implants are ultrasonically cleaned they are laser etched
by using an NdYAG laser at a power of 50kw frequency of 75khz
and 164A current
They are then processed in an electrolyte solution with 35
glyceroposphate disodium salt pentahydrate and 12 calcium
acetate monohydrate by microarc oxidation (voltage 350v
frequency 800hz) for 15 seconds
Microarc oxidation produces a titania film with a porous structure
and micropores of 1-5microm
The mechanism of osseointegration of the oxidized implants has
been shown to be mechanical interlocking and biochemical
bonding
Surface coating Ti Plasma Spray
Porous rough Ti surface have been fabricated by plasma
spraying a Ti powder form of molten droplets at high temperature
at temperature in order of 15000C at 600ms
The Ti plasma spray after solidification often provides 004 ndash 005
mm thickness
Ti A spray has been reported to increase the surface area of bone
to implant interface (as much as 600) and stimulate adhesion
osteogenesis
Advantages
Enhance attachment by increasing ionic interactions
Increased load bearing capability by 25-30
Increased tensile strength through ingrowth of bony tissues into 3D feature
Disadvantages
Cracking and scaling of coating because of stresses produced by elevated temprature processing
Risk of accumulation of abraded material in the interface zone during implantation of TPS
Hydroxyapatite coatings
Hydroxyapatite [Ca10(PO4)6OH]2 coating was brought to the
dental profession by DeGroot
HA forms a strong chemical bond with bone due to the presence
of free calcium and phosphate compounds at the implant surface
The HA coating consists of amorphous and crystalline forms with
a large density of cracks
The top 1-2 microm of the HA layer being amorphous while the rest
of the crystalline layer is hexagonally packed
Indicated Fresh extraction sites
Newly grafted sites
Advantages
1 Protection of surrounding bone against metal ion release from the
substrate
2 Reported chemical bonding between HA and living bone-intimate
contact-biointegration
3 Partial dissolution of HA makes surrounding fluid rich in calcium
and phosphate ions which trigger cellular differentiation and bone
formation
Disadvantages
Induction of impurities due to thermal decomposition during
processing- affecting long term clinical fixation
Dissolution of HA at lower pH
HA coating on the implant surface (50-70microm) by various methods
1 Plasma spraying
2 The vacuum deposition technique(ion beam sputtering radiofrequency
sputtering)
3 The sol gel and dip coating method
4 Electrolytic process
Nanotitania coatings
Nanotitania coatings were prepared by using the sol-gel
technique
Nanotitania implants had an increased feature density and a large
feature coverage area as compared to the nano-HA implants
This could present more binding sites for the protein cell
attachment and for increased bone contact
he Nanotitania implants exhibited an ordered arrangement
forming a homogenous layer on underlying topography
Biologically active drugs incorporated dental
implants
Bisphosphonates Bisphosphate-loaded implant surfaces have
been reported to improve implant osseointegration
Simvastatin
Simvastatin could induce the expression of bone morphogenetic
protein (BMP) mRNA that might promote bone formation and
increase bone mineral density
Gentamycin along with the layer of HA can be coated onto the
implant surface which may act as a local prophylactic agent along
with the systemic antibiotics in dental implant surgery
Biochemical Methods
of the Surface
Modifications
Biochemical Methods of the Surface
Modifications
Their goal is to immobilize proteins enzymes or peptides on
biomaterials for the purpose of inducing specific cell and tissue
responses
1 One approach uses cell-adhesion molecules like fibronectin
vitronectin Type I collagen osteogenin and bone sialoprotein
2 The second approach uses biomolecules with osteotropic
effects which range from mitogenicity (interleukin growth
factor-I FGF-2 platelet derived growth factor ndashBB) to the
increasing activity of the bone cells which enhances the
collagen synthesis for osteoinduction
Zirconia implants
Zirconia (Zr02) is a ceramic material used in implantology because
Biocompatibility(bio inert)
Esthetics (because its colour is similar to the teeth) and
Mechanical properties which are better than alumina
High resistance to corrosion flexion and fracture
Contact with bone and soft tissue similar to that observed in
titanium implants
It can be used to produce a entire implant or as a coating
Advantages of Zirconia Dental Implants
No dark colour of the metal showing through the gums
No corrosion of the zirconia as with titanium
No piezo-electric currents between dissimilar metal in
the mouth
It is thermally non-conductive
Greater BIC (Bone ndash Implant Contact)
20 more bone apposition than titanium implants
Zeynep Ouml zkurt Zirconia Dental Implants A Literature Review Journal of Oral Implantology Vol 37(3)2011
RTQ (removal torque testing) Gahlert et al evaluated the RTQ values of
machined zirconia implants sandblasted zirconia implants and SLA titanium
implants The mean RTQ for machined zirconia implants was 259 Ncm the
mean RTQ for zirconia rough implants was 405 Ncm and the mean RTQ for
SLA titanium implants was 1052 Ncm
Fracture strength within clinically acceptable limits
Stress analysis Kohal et al observed the stress distribution patterns of
zirconia implants (ReImplant) which were found to have low well distributed
and similar stress distribution compared with titanium implants
PEEK implants (poly etheretherketone)
These implants are available in three fundamentally different
designs
TAU Diameter -48 mm lengths 10 125 15 mm
immediate loading possible
Low density bone
THETA Similar to TAU but D1 bone
IOTA It is a 3mm diameter implant (10 and 12 mm)
used in narrow ridges
Advantages
Good strengthfracture resistance and bioinertness
Promotes human oseteoblast cell growth
Disadvantages
Faintly radiopaque ndashdifficult for post-op evaluation
Lengths and diameters range is restricted
Advances in
commercially
available implant
systems
LASER- LOK TECHNOLOGY
Unique surface characteristics
Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using
laser ablation technology
Extremely consistent microchannels that are optimally
sized to attach and organize both osteoblasts and
fibroblasts
Includes a repeating nanostructure that maximizes
surface area and enables cell pseudopodia and collagen
microfibrils to interdigitate with the Laser-Lok surface
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
The recorded implant survival rates were above 90 in all the
studies Six studies published a survival rate of 100 at the end of
the follow-up period
The lowest survival rate (909) corresponded to the study
published by Barter et al
58 failures (implant loss) were recorded out of a total of 2980
implants
A larger number of failures were recorded with implants measuring
le 13 mm in length
Nineteen studies measured changes in peri-implant bone height
after implant loading 0065 mm the first year to 174 mm after a
follow-up period of 10 years
Araujo published a retrospective study on 33 mm implants placed
in posterior areas and rehabilitated following an immediate loading
protocol
Implant survival rate was 955 after 9 years of follow-up
That same year Degidi et al published a study comparing delayed
and immediate loading in narrow-diameter implants placed in both
anterior and posterior zones
Survival rate was 994 after a mean follow-up of 20 months
TRANSITIONAL IMPLANTS
Diameter ranges -18 to 28 mm
Length -7mm to 14mm
Fabricated with pure titanium in a single body with treated
surface
Primary function is to absorb masticatory stress during healing
phase
They should be placed at least 15 mm from adjacent teeth and
the distance between any transitional implant and a definitive
implant must be at least 15-2 mm
The abutment head generally has a 5 degree taper which makes it
optimal for retention of cement retained prostheses
Only one drill a 15 mm or 2 mm twist drill is required for
placement of the implants
Advantages
Provisionalisation of fully and partially edentulous jaws
Undisturbed healing of bone grafts
Effective way to generate aesthetic transitional appliances
Allows evaluation of phonetics and function
Cost effective
One ndash Piece Implants
The implant is machined from a piece of titanium that
incorporates both the implant body and an integral fixed abutment
in a single component
3 diameters -35 43 and 5 mm
4 lengths -10 13 15 and 16 mm
Clinical and radiographic evaluation of one-piece implants
used for immediate function
Jack a Hahn journal of oral implantology vol 33(3)2007
The aim of the present research was to evaluate the radiographic
outcome of a 1-piece implant when used for immediate function in
an ordinary patient pool
Forty-seven NobelDirect and NobelPerfect 1-piece implants
(Nobel Biocare Goumlteborg Sweden) were placed in maxillae and
mandibles
In this study 1 of the 47 implants had to be removed resulting in a
cumulative implant survival rate of 979 throughout the follow-up
period
The mean marginal bone level relative to the reference point after
1 year of loading (078 - 160 mm) as well as after 2 and 3 years of
loading was located above the first implant thread
In this study a bone level 2 mm apical to the reference point after
1 year of loading was observed at 2 implants (6)
The 1-piece implant design enables undisturbed healing
of the peri-implant soft tissue and avoids disruption of the
soft tissue seal when placing the definitive prosthetic
restoration
Annibali et al reported a series of patients treated
consecutively for first molar replacement according to
Immediate = group 1
Early = group 2
Late = Group 3
The implant survival rate
917 for early implants
950 for immediate post-extraction implants
100 for implants placed in healed sites
Short Dental Implants
A dental implant with length of 7 mm or less (Friberg et al 2000)
Any implant under 10 mm in length referred to as a lsquolsquoshortrsquorsquo
implant (Griffin TJ Cheung WS 2004)
A device with an intra-bony length of 8 mm or less (Renouard
and Nisand 2006)
Indication
Atropic Jaw
Proximity to vital structure
Single crowns
Overdentures
Advantages
1 Bone grafting for height often unnecessary
2 Less money pain and time prior to restoration of the implant
3 Simplified bone surgery
4 Implant insertion easier
Goodacre et al in 2003 reviewed
2754 implants - lt10 mm
3015 implants - gt10 mm in length
The failure rate of implants 10 mm or less was 10 compared
to a 3 failure rate of implants longer than 10 mm
Ivanoff et al in 1999 found an 8-mm-long 5-mm-diameter
implant failed 25 of the time in the maxilla and 33 of the
time in the mandible On the other hand the 10-mm and 12-
mm implants that were 5 mm in diameter reported no
mandibular failure and a 10 failure in the maxilla
Misch CE Short Dental Implants A Literature Review and Rationale for Use Dent Today 2005 Aug24(8)64-6 68
On the other hand a retrospective report by Misch et al was compiled
from 2 private offices using a square thread implant body design
(BioHorizons) rather than a v-shaped thread as primarily reported in the
previous literature
During a 3-year period 126 patients received implants less than 10 mm
long
Of the 437 implants there were 3 implant failures in the posterior
mandible and 1 failure in the posterior maxilla (99 survival)
All these failures were implants 9 mm long and 4 mm in diameter
Advances in Implant materials
Previously implants had macro-irregularities like macroscopic
threads fenestrations pores grooves steps threads or other
surface irregularities that were visible
However difficulty in achieving initial stability post implantation
relative motion adverse interfacial bone remodelling all lead to
search for improvement of the surface quality of a titanium dental
implant
BLASTING
Blasting -aluminium oxide titanium oxide and calcium phosphate
with particle size ranging from small medium to large (150- 350
microm)
Blasting a smooth Ti surface with Al2 O3 particles of 25 microm 75 microm
or 250 microm produces surfaces with roughness values of 116 to 120
143 and 194 to 220 respectively
A series of investigations have demonstrated a firmer bone
fixation of the implant with an average surface roughness (sa) of 1-
15microm than those of smoother implants with an average surface
roughness of 06microm
Blasting and Acid Etching
Acid etching can be done by using an HCL H2 SO4 mixture or by
pickling in 2 HF10HNO3 These processes leave pits and craters
Alumina or TiO2 for blasting the surface
Small - 25μm
large grit -025-05mm
medium grit - 250-500μm
Sand blasted and acid etched surfaces have a hydrophobic surface
The etching leads to the formation of Titanium hydrides and the
replacement of hydride by oxygen results in the slow transformation of
the implant surface resulting in nanometre sized particles of titanium on
the surface which helps in protein adhesion on implant surface
Dual acid etching with HCl and H2SO4 heated above 100ᴼC has
produced surface topography able to attach to fibrin scaffold and
promote adhesion of osteogenic cells
Sand blasting and etching can increase the rate and amount of the
bone formation
Flouride Surface Treatments
This treatment enhances osseointegration and osteoblastic
differentitation with increased expression of Cbfa1 osterix and
bone sialoprotein
Fluoridated rough implants also withstood greater push-out
forces and showed a significantly higher removal torque than
control implants
However detrimental effect of F on the corrosion resistance of
titanium and titanium alloys has been extensively reported
Anodized Surface Implants
Anodized surface implants are implants which are placed as anodes
in galvanic cells with phosphoric acid as the electrolyte and current is
passed through them ndash also ca ldquoTiunite surfacerdquo
The surface oxides grow from the native state of 5nm to
approximately 10000nm
The sa of TiUnite is reported to be 11microm and its sdr 37
Anodic oxidation results in the growth of a native titanium oxide
layer and a porous topography with the bone formation occurring
directly on the moderately rough oxidized surface
Clinical and Radiographic Evaluation of Braringnemark Implants with an
Anodized Surface following Seven-to-Eight Years of Functional Loading
David Gelb Bradley McaAllister et al Int J Dent 2013 2013 583567
The aim of this study was to evaluate the clinical and
radiographic long-term outcomes of dental implants with an
anodized TiUnite surface placed in routine clinical practice
38 single prosthesis
22 FPDs
80 implants in maxilla
27 in mandible
Mean marginal bone level change-149 plusmn 103 mm
907 of cases- no visible plaque93 -visible plaque
No prosthetic complication
Calandriello evaluated immediately placed anodized
implants in 33 patients and found a mean marginal bone
loss of 117thinspmm after 5 years
Friberg and Jemt compared 280 TiUnite implants to 110
machined implants in 111 patients and found marginal
bone loss after 5 years to be 075 and 06thinspmm respectively
with no significant difference between the two types of
implants
Laser etching and Micro Arc Oxidation
After the implants are ultrasonically cleaned they are laser etched
by using an NdYAG laser at a power of 50kw frequency of 75khz
and 164A current
They are then processed in an electrolyte solution with 35
glyceroposphate disodium salt pentahydrate and 12 calcium
acetate monohydrate by microarc oxidation (voltage 350v
frequency 800hz) for 15 seconds
Microarc oxidation produces a titania film with a porous structure
and micropores of 1-5microm
The mechanism of osseointegration of the oxidized implants has
been shown to be mechanical interlocking and biochemical
bonding
Surface coating Ti Plasma Spray
Porous rough Ti surface have been fabricated by plasma
spraying a Ti powder form of molten droplets at high temperature
at temperature in order of 15000C at 600ms
The Ti plasma spray after solidification often provides 004 ndash 005
mm thickness
Ti A spray has been reported to increase the surface area of bone
to implant interface (as much as 600) and stimulate adhesion
osteogenesis
Advantages
Enhance attachment by increasing ionic interactions
Increased load bearing capability by 25-30
Increased tensile strength through ingrowth of bony tissues into 3D feature
Disadvantages
Cracking and scaling of coating because of stresses produced by elevated temprature processing
Risk of accumulation of abraded material in the interface zone during implantation of TPS
Hydroxyapatite coatings
Hydroxyapatite [Ca10(PO4)6OH]2 coating was brought to the
dental profession by DeGroot
HA forms a strong chemical bond with bone due to the presence
of free calcium and phosphate compounds at the implant surface
The HA coating consists of amorphous and crystalline forms with
a large density of cracks
The top 1-2 microm of the HA layer being amorphous while the rest
of the crystalline layer is hexagonally packed
Indicated Fresh extraction sites
Newly grafted sites
Advantages
1 Protection of surrounding bone against metal ion release from the
substrate
2 Reported chemical bonding between HA and living bone-intimate
contact-biointegration
3 Partial dissolution of HA makes surrounding fluid rich in calcium
and phosphate ions which trigger cellular differentiation and bone
formation
Disadvantages
Induction of impurities due to thermal decomposition during
processing- affecting long term clinical fixation
Dissolution of HA at lower pH
HA coating on the implant surface (50-70microm) by various methods
1 Plasma spraying
2 The vacuum deposition technique(ion beam sputtering radiofrequency
sputtering)
3 The sol gel and dip coating method
4 Electrolytic process
Nanotitania coatings
Nanotitania coatings were prepared by using the sol-gel
technique
Nanotitania implants had an increased feature density and a large
feature coverage area as compared to the nano-HA implants
This could present more binding sites for the protein cell
attachment and for increased bone contact
he Nanotitania implants exhibited an ordered arrangement
forming a homogenous layer on underlying topography
Biologically active drugs incorporated dental
implants
Bisphosphonates Bisphosphate-loaded implant surfaces have
been reported to improve implant osseointegration
Simvastatin
Simvastatin could induce the expression of bone morphogenetic
protein (BMP) mRNA that might promote bone formation and
increase bone mineral density
Gentamycin along with the layer of HA can be coated onto the
implant surface which may act as a local prophylactic agent along
with the systemic antibiotics in dental implant surgery
Biochemical Methods
of the Surface
Modifications
Biochemical Methods of the Surface
Modifications
Their goal is to immobilize proteins enzymes or peptides on
biomaterials for the purpose of inducing specific cell and tissue
responses
1 One approach uses cell-adhesion molecules like fibronectin
vitronectin Type I collagen osteogenin and bone sialoprotein
2 The second approach uses biomolecules with osteotropic
effects which range from mitogenicity (interleukin growth
factor-I FGF-2 platelet derived growth factor ndashBB) to the
increasing activity of the bone cells which enhances the
collagen synthesis for osteoinduction
Zirconia implants
Zirconia (Zr02) is a ceramic material used in implantology because
Biocompatibility(bio inert)
Esthetics (because its colour is similar to the teeth) and
Mechanical properties which are better than alumina
High resistance to corrosion flexion and fracture
Contact with bone and soft tissue similar to that observed in
titanium implants
It can be used to produce a entire implant or as a coating
Advantages of Zirconia Dental Implants
No dark colour of the metal showing through the gums
No corrosion of the zirconia as with titanium
No piezo-electric currents between dissimilar metal in
the mouth
It is thermally non-conductive
Greater BIC (Bone ndash Implant Contact)
20 more bone apposition than titanium implants
Zeynep Ouml zkurt Zirconia Dental Implants A Literature Review Journal of Oral Implantology Vol 37(3)2011
RTQ (removal torque testing) Gahlert et al evaluated the RTQ values of
machined zirconia implants sandblasted zirconia implants and SLA titanium
implants The mean RTQ for machined zirconia implants was 259 Ncm the
mean RTQ for zirconia rough implants was 405 Ncm and the mean RTQ for
SLA titanium implants was 1052 Ncm
Fracture strength within clinically acceptable limits
Stress analysis Kohal et al observed the stress distribution patterns of
zirconia implants (ReImplant) which were found to have low well distributed
and similar stress distribution compared with titanium implants
PEEK implants (poly etheretherketone)
These implants are available in three fundamentally different
designs
TAU Diameter -48 mm lengths 10 125 15 mm
immediate loading possible
Low density bone
THETA Similar to TAU but D1 bone
IOTA It is a 3mm diameter implant (10 and 12 mm)
used in narrow ridges
Advantages
Good strengthfracture resistance and bioinertness
Promotes human oseteoblast cell growth
Disadvantages
Faintly radiopaque ndashdifficult for post-op evaluation
Lengths and diameters range is restricted
Advances in
commercially
available implant
systems
LASER- LOK TECHNOLOGY
Unique surface characteristics
Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using
laser ablation technology
Extremely consistent microchannels that are optimally
sized to attach and organize both osteoblasts and
fibroblasts
Includes a repeating nanostructure that maximizes
surface area and enables cell pseudopodia and collagen
microfibrils to interdigitate with the Laser-Lok surface
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Araujo published a retrospective study on 33 mm implants placed
in posterior areas and rehabilitated following an immediate loading
protocol
Implant survival rate was 955 after 9 years of follow-up
That same year Degidi et al published a study comparing delayed
and immediate loading in narrow-diameter implants placed in both
anterior and posterior zones
Survival rate was 994 after a mean follow-up of 20 months
TRANSITIONAL IMPLANTS
Diameter ranges -18 to 28 mm
Length -7mm to 14mm
Fabricated with pure titanium in a single body with treated
surface
Primary function is to absorb masticatory stress during healing
phase
They should be placed at least 15 mm from adjacent teeth and
the distance between any transitional implant and a definitive
implant must be at least 15-2 mm
The abutment head generally has a 5 degree taper which makes it
optimal for retention of cement retained prostheses
Only one drill a 15 mm or 2 mm twist drill is required for
placement of the implants
Advantages
Provisionalisation of fully and partially edentulous jaws
Undisturbed healing of bone grafts
Effective way to generate aesthetic transitional appliances
Allows evaluation of phonetics and function
Cost effective
One ndash Piece Implants
The implant is machined from a piece of titanium that
incorporates both the implant body and an integral fixed abutment
in a single component
3 diameters -35 43 and 5 mm
4 lengths -10 13 15 and 16 mm
Clinical and radiographic evaluation of one-piece implants
used for immediate function
Jack a Hahn journal of oral implantology vol 33(3)2007
The aim of the present research was to evaluate the radiographic
outcome of a 1-piece implant when used for immediate function in
an ordinary patient pool
Forty-seven NobelDirect and NobelPerfect 1-piece implants
(Nobel Biocare Goumlteborg Sweden) were placed in maxillae and
mandibles
In this study 1 of the 47 implants had to be removed resulting in a
cumulative implant survival rate of 979 throughout the follow-up
period
The mean marginal bone level relative to the reference point after
1 year of loading (078 - 160 mm) as well as after 2 and 3 years of
loading was located above the first implant thread
In this study a bone level 2 mm apical to the reference point after
1 year of loading was observed at 2 implants (6)
The 1-piece implant design enables undisturbed healing
of the peri-implant soft tissue and avoids disruption of the
soft tissue seal when placing the definitive prosthetic
restoration
Annibali et al reported a series of patients treated
consecutively for first molar replacement according to
Immediate = group 1
Early = group 2
Late = Group 3
The implant survival rate
917 for early implants
950 for immediate post-extraction implants
100 for implants placed in healed sites
Short Dental Implants
A dental implant with length of 7 mm or less (Friberg et al 2000)
Any implant under 10 mm in length referred to as a lsquolsquoshortrsquorsquo
implant (Griffin TJ Cheung WS 2004)
A device with an intra-bony length of 8 mm or less (Renouard
and Nisand 2006)
Indication
Atropic Jaw
Proximity to vital structure
Single crowns
Overdentures
Advantages
1 Bone grafting for height often unnecessary
2 Less money pain and time prior to restoration of the implant
3 Simplified bone surgery
4 Implant insertion easier
Goodacre et al in 2003 reviewed
2754 implants - lt10 mm
3015 implants - gt10 mm in length
The failure rate of implants 10 mm or less was 10 compared
to a 3 failure rate of implants longer than 10 mm
Ivanoff et al in 1999 found an 8-mm-long 5-mm-diameter
implant failed 25 of the time in the maxilla and 33 of the
time in the mandible On the other hand the 10-mm and 12-
mm implants that were 5 mm in diameter reported no
mandibular failure and a 10 failure in the maxilla
Misch CE Short Dental Implants A Literature Review and Rationale for Use Dent Today 2005 Aug24(8)64-6 68
On the other hand a retrospective report by Misch et al was compiled
from 2 private offices using a square thread implant body design
(BioHorizons) rather than a v-shaped thread as primarily reported in the
previous literature
During a 3-year period 126 patients received implants less than 10 mm
long
Of the 437 implants there were 3 implant failures in the posterior
mandible and 1 failure in the posterior maxilla (99 survival)
All these failures were implants 9 mm long and 4 mm in diameter
Advances in Implant materials
Previously implants had macro-irregularities like macroscopic
threads fenestrations pores grooves steps threads or other
surface irregularities that were visible
However difficulty in achieving initial stability post implantation
relative motion adverse interfacial bone remodelling all lead to
search for improvement of the surface quality of a titanium dental
implant
BLASTING
Blasting -aluminium oxide titanium oxide and calcium phosphate
with particle size ranging from small medium to large (150- 350
microm)
Blasting a smooth Ti surface with Al2 O3 particles of 25 microm 75 microm
or 250 microm produces surfaces with roughness values of 116 to 120
143 and 194 to 220 respectively
A series of investigations have demonstrated a firmer bone
fixation of the implant with an average surface roughness (sa) of 1-
15microm than those of smoother implants with an average surface
roughness of 06microm
Blasting and Acid Etching
Acid etching can be done by using an HCL H2 SO4 mixture or by
pickling in 2 HF10HNO3 These processes leave pits and craters
Alumina or TiO2 for blasting the surface
Small - 25μm
large grit -025-05mm
medium grit - 250-500μm
Sand blasted and acid etched surfaces have a hydrophobic surface
The etching leads to the formation of Titanium hydrides and the
replacement of hydride by oxygen results in the slow transformation of
the implant surface resulting in nanometre sized particles of titanium on
the surface which helps in protein adhesion on implant surface
Dual acid etching with HCl and H2SO4 heated above 100ᴼC has
produced surface topography able to attach to fibrin scaffold and
promote adhesion of osteogenic cells
Sand blasting and etching can increase the rate and amount of the
bone formation
Flouride Surface Treatments
This treatment enhances osseointegration and osteoblastic
differentitation with increased expression of Cbfa1 osterix and
bone sialoprotein
Fluoridated rough implants also withstood greater push-out
forces and showed a significantly higher removal torque than
control implants
However detrimental effect of F on the corrosion resistance of
titanium and titanium alloys has been extensively reported
Anodized Surface Implants
Anodized surface implants are implants which are placed as anodes
in galvanic cells with phosphoric acid as the electrolyte and current is
passed through them ndash also ca ldquoTiunite surfacerdquo
The surface oxides grow from the native state of 5nm to
approximately 10000nm
The sa of TiUnite is reported to be 11microm and its sdr 37
Anodic oxidation results in the growth of a native titanium oxide
layer and a porous topography with the bone formation occurring
directly on the moderately rough oxidized surface
Clinical and Radiographic Evaluation of Braringnemark Implants with an
Anodized Surface following Seven-to-Eight Years of Functional Loading
David Gelb Bradley McaAllister et al Int J Dent 2013 2013 583567
The aim of this study was to evaluate the clinical and
radiographic long-term outcomes of dental implants with an
anodized TiUnite surface placed in routine clinical practice
38 single prosthesis
22 FPDs
80 implants in maxilla
27 in mandible
Mean marginal bone level change-149 plusmn 103 mm
907 of cases- no visible plaque93 -visible plaque
No prosthetic complication
Calandriello evaluated immediately placed anodized
implants in 33 patients and found a mean marginal bone
loss of 117thinspmm after 5 years
Friberg and Jemt compared 280 TiUnite implants to 110
machined implants in 111 patients and found marginal
bone loss after 5 years to be 075 and 06thinspmm respectively
with no significant difference between the two types of
implants
Laser etching and Micro Arc Oxidation
After the implants are ultrasonically cleaned they are laser etched
by using an NdYAG laser at a power of 50kw frequency of 75khz
and 164A current
They are then processed in an electrolyte solution with 35
glyceroposphate disodium salt pentahydrate and 12 calcium
acetate monohydrate by microarc oxidation (voltage 350v
frequency 800hz) for 15 seconds
Microarc oxidation produces a titania film with a porous structure
and micropores of 1-5microm
The mechanism of osseointegration of the oxidized implants has
been shown to be mechanical interlocking and biochemical
bonding
Surface coating Ti Plasma Spray
Porous rough Ti surface have been fabricated by plasma
spraying a Ti powder form of molten droplets at high temperature
at temperature in order of 15000C at 600ms
The Ti plasma spray after solidification often provides 004 ndash 005
mm thickness
Ti A spray has been reported to increase the surface area of bone
to implant interface (as much as 600) and stimulate adhesion
osteogenesis
Advantages
Enhance attachment by increasing ionic interactions
Increased load bearing capability by 25-30
Increased tensile strength through ingrowth of bony tissues into 3D feature
Disadvantages
Cracking and scaling of coating because of stresses produced by elevated temprature processing
Risk of accumulation of abraded material in the interface zone during implantation of TPS
Hydroxyapatite coatings
Hydroxyapatite [Ca10(PO4)6OH]2 coating was brought to the
dental profession by DeGroot
HA forms a strong chemical bond with bone due to the presence
of free calcium and phosphate compounds at the implant surface
The HA coating consists of amorphous and crystalline forms with
a large density of cracks
The top 1-2 microm of the HA layer being amorphous while the rest
of the crystalline layer is hexagonally packed
Indicated Fresh extraction sites
Newly grafted sites
Advantages
1 Protection of surrounding bone against metal ion release from the
substrate
2 Reported chemical bonding between HA and living bone-intimate
contact-biointegration
3 Partial dissolution of HA makes surrounding fluid rich in calcium
and phosphate ions which trigger cellular differentiation and bone
formation
Disadvantages
Induction of impurities due to thermal decomposition during
processing- affecting long term clinical fixation
Dissolution of HA at lower pH
HA coating on the implant surface (50-70microm) by various methods
1 Plasma spraying
2 The vacuum deposition technique(ion beam sputtering radiofrequency
sputtering)
3 The sol gel and dip coating method
4 Electrolytic process
Nanotitania coatings
Nanotitania coatings were prepared by using the sol-gel
technique
Nanotitania implants had an increased feature density and a large
feature coverage area as compared to the nano-HA implants
This could present more binding sites for the protein cell
attachment and for increased bone contact
he Nanotitania implants exhibited an ordered arrangement
forming a homogenous layer on underlying topography
Biologically active drugs incorporated dental
implants
Bisphosphonates Bisphosphate-loaded implant surfaces have
been reported to improve implant osseointegration
Simvastatin
Simvastatin could induce the expression of bone morphogenetic
protein (BMP) mRNA that might promote bone formation and
increase bone mineral density
Gentamycin along with the layer of HA can be coated onto the
implant surface which may act as a local prophylactic agent along
with the systemic antibiotics in dental implant surgery
Biochemical Methods
of the Surface
Modifications
Biochemical Methods of the Surface
Modifications
Their goal is to immobilize proteins enzymes or peptides on
biomaterials for the purpose of inducing specific cell and tissue
responses
1 One approach uses cell-adhesion molecules like fibronectin
vitronectin Type I collagen osteogenin and bone sialoprotein
2 The second approach uses biomolecules with osteotropic
effects which range from mitogenicity (interleukin growth
factor-I FGF-2 platelet derived growth factor ndashBB) to the
increasing activity of the bone cells which enhances the
collagen synthesis for osteoinduction
Zirconia implants
Zirconia (Zr02) is a ceramic material used in implantology because
Biocompatibility(bio inert)
Esthetics (because its colour is similar to the teeth) and
Mechanical properties which are better than alumina
High resistance to corrosion flexion and fracture
Contact with bone and soft tissue similar to that observed in
titanium implants
It can be used to produce a entire implant or as a coating
Advantages of Zirconia Dental Implants
No dark colour of the metal showing through the gums
No corrosion of the zirconia as with titanium
No piezo-electric currents between dissimilar metal in
the mouth
It is thermally non-conductive
Greater BIC (Bone ndash Implant Contact)
20 more bone apposition than titanium implants
Zeynep Ouml zkurt Zirconia Dental Implants A Literature Review Journal of Oral Implantology Vol 37(3)2011
RTQ (removal torque testing) Gahlert et al evaluated the RTQ values of
machined zirconia implants sandblasted zirconia implants and SLA titanium
implants The mean RTQ for machined zirconia implants was 259 Ncm the
mean RTQ for zirconia rough implants was 405 Ncm and the mean RTQ for
SLA titanium implants was 1052 Ncm
Fracture strength within clinically acceptable limits
Stress analysis Kohal et al observed the stress distribution patterns of
zirconia implants (ReImplant) which were found to have low well distributed
and similar stress distribution compared with titanium implants
PEEK implants (poly etheretherketone)
These implants are available in three fundamentally different
designs
TAU Diameter -48 mm lengths 10 125 15 mm
immediate loading possible
Low density bone
THETA Similar to TAU but D1 bone
IOTA It is a 3mm diameter implant (10 and 12 mm)
used in narrow ridges
Advantages
Good strengthfracture resistance and bioinertness
Promotes human oseteoblast cell growth
Disadvantages
Faintly radiopaque ndashdifficult for post-op evaluation
Lengths and diameters range is restricted
Advances in
commercially
available implant
systems
LASER- LOK TECHNOLOGY
Unique surface characteristics
Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using
laser ablation technology
Extremely consistent microchannels that are optimally
sized to attach and organize both osteoblasts and
fibroblasts
Includes a repeating nanostructure that maximizes
surface area and enables cell pseudopodia and collagen
microfibrils to interdigitate with the Laser-Lok surface
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
TRANSITIONAL IMPLANTS
Diameter ranges -18 to 28 mm
Length -7mm to 14mm
Fabricated with pure titanium in a single body with treated
surface
Primary function is to absorb masticatory stress during healing
phase
They should be placed at least 15 mm from adjacent teeth and
the distance between any transitional implant and a definitive
implant must be at least 15-2 mm
The abutment head generally has a 5 degree taper which makes it
optimal for retention of cement retained prostheses
Only one drill a 15 mm or 2 mm twist drill is required for
placement of the implants
Advantages
Provisionalisation of fully and partially edentulous jaws
Undisturbed healing of bone grafts
Effective way to generate aesthetic transitional appliances
Allows evaluation of phonetics and function
Cost effective
One ndash Piece Implants
The implant is machined from a piece of titanium that
incorporates both the implant body and an integral fixed abutment
in a single component
3 diameters -35 43 and 5 mm
4 lengths -10 13 15 and 16 mm
Clinical and radiographic evaluation of one-piece implants
used for immediate function
Jack a Hahn journal of oral implantology vol 33(3)2007
The aim of the present research was to evaluate the radiographic
outcome of a 1-piece implant when used for immediate function in
an ordinary patient pool
Forty-seven NobelDirect and NobelPerfect 1-piece implants
(Nobel Biocare Goumlteborg Sweden) were placed in maxillae and
mandibles
In this study 1 of the 47 implants had to be removed resulting in a
cumulative implant survival rate of 979 throughout the follow-up
period
The mean marginal bone level relative to the reference point after
1 year of loading (078 - 160 mm) as well as after 2 and 3 years of
loading was located above the first implant thread
In this study a bone level 2 mm apical to the reference point after
1 year of loading was observed at 2 implants (6)
The 1-piece implant design enables undisturbed healing
of the peri-implant soft tissue and avoids disruption of the
soft tissue seal when placing the definitive prosthetic
restoration
Annibali et al reported a series of patients treated
consecutively for first molar replacement according to
Immediate = group 1
Early = group 2
Late = Group 3
The implant survival rate
917 for early implants
950 for immediate post-extraction implants
100 for implants placed in healed sites
Short Dental Implants
A dental implant with length of 7 mm or less (Friberg et al 2000)
Any implant under 10 mm in length referred to as a lsquolsquoshortrsquorsquo
implant (Griffin TJ Cheung WS 2004)
A device with an intra-bony length of 8 mm or less (Renouard
and Nisand 2006)
Indication
Atropic Jaw
Proximity to vital structure
Single crowns
Overdentures
Advantages
1 Bone grafting for height often unnecessary
2 Less money pain and time prior to restoration of the implant
3 Simplified bone surgery
4 Implant insertion easier
Goodacre et al in 2003 reviewed
2754 implants - lt10 mm
3015 implants - gt10 mm in length
The failure rate of implants 10 mm or less was 10 compared
to a 3 failure rate of implants longer than 10 mm
Ivanoff et al in 1999 found an 8-mm-long 5-mm-diameter
implant failed 25 of the time in the maxilla and 33 of the
time in the mandible On the other hand the 10-mm and 12-
mm implants that were 5 mm in diameter reported no
mandibular failure and a 10 failure in the maxilla
Misch CE Short Dental Implants A Literature Review and Rationale for Use Dent Today 2005 Aug24(8)64-6 68
On the other hand a retrospective report by Misch et al was compiled
from 2 private offices using a square thread implant body design
(BioHorizons) rather than a v-shaped thread as primarily reported in the
previous literature
During a 3-year period 126 patients received implants less than 10 mm
long
Of the 437 implants there were 3 implant failures in the posterior
mandible and 1 failure in the posterior maxilla (99 survival)
All these failures were implants 9 mm long and 4 mm in diameter
Advances in Implant materials
Previously implants had macro-irregularities like macroscopic
threads fenestrations pores grooves steps threads or other
surface irregularities that were visible
However difficulty in achieving initial stability post implantation
relative motion adverse interfacial bone remodelling all lead to
search for improvement of the surface quality of a titanium dental
implant
BLASTING
Blasting -aluminium oxide titanium oxide and calcium phosphate
with particle size ranging from small medium to large (150- 350
microm)
Blasting a smooth Ti surface with Al2 O3 particles of 25 microm 75 microm
or 250 microm produces surfaces with roughness values of 116 to 120
143 and 194 to 220 respectively
A series of investigations have demonstrated a firmer bone
fixation of the implant with an average surface roughness (sa) of 1-
15microm than those of smoother implants with an average surface
roughness of 06microm
Blasting and Acid Etching
Acid etching can be done by using an HCL H2 SO4 mixture or by
pickling in 2 HF10HNO3 These processes leave pits and craters
Alumina or TiO2 for blasting the surface
Small - 25μm
large grit -025-05mm
medium grit - 250-500μm
Sand blasted and acid etched surfaces have a hydrophobic surface
The etching leads to the formation of Titanium hydrides and the
replacement of hydride by oxygen results in the slow transformation of
the implant surface resulting in nanometre sized particles of titanium on
the surface which helps in protein adhesion on implant surface
Dual acid etching with HCl and H2SO4 heated above 100ᴼC has
produced surface topography able to attach to fibrin scaffold and
promote adhesion of osteogenic cells
Sand blasting and etching can increase the rate and amount of the
bone formation
Flouride Surface Treatments
This treatment enhances osseointegration and osteoblastic
differentitation with increased expression of Cbfa1 osterix and
bone sialoprotein
Fluoridated rough implants also withstood greater push-out
forces and showed a significantly higher removal torque than
control implants
However detrimental effect of F on the corrosion resistance of
titanium and titanium alloys has been extensively reported
Anodized Surface Implants
Anodized surface implants are implants which are placed as anodes
in galvanic cells with phosphoric acid as the electrolyte and current is
passed through them ndash also ca ldquoTiunite surfacerdquo
The surface oxides grow from the native state of 5nm to
approximately 10000nm
The sa of TiUnite is reported to be 11microm and its sdr 37
Anodic oxidation results in the growth of a native titanium oxide
layer and a porous topography with the bone formation occurring
directly on the moderately rough oxidized surface
Clinical and Radiographic Evaluation of Braringnemark Implants with an
Anodized Surface following Seven-to-Eight Years of Functional Loading
David Gelb Bradley McaAllister et al Int J Dent 2013 2013 583567
The aim of this study was to evaluate the clinical and
radiographic long-term outcomes of dental implants with an
anodized TiUnite surface placed in routine clinical practice
38 single prosthesis
22 FPDs
80 implants in maxilla
27 in mandible
Mean marginal bone level change-149 plusmn 103 mm
907 of cases- no visible plaque93 -visible plaque
No prosthetic complication
Calandriello evaluated immediately placed anodized
implants in 33 patients and found a mean marginal bone
loss of 117thinspmm after 5 years
Friberg and Jemt compared 280 TiUnite implants to 110
machined implants in 111 patients and found marginal
bone loss after 5 years to be 075 and 06thinspmm respectively
with no significant difference between the two types of
implants
Laser etching and Micro Arc Oxidation
After the implants are ultrasonically cleaned they are laser etched
by using an NdYAG laser at a power of 50kw frequency of 75khz
and 164A current
They are then processed in an electrolyte solution with 35
glyceroposphate disodium salt pentahydrate and 12 calcium
acetate monohydrate by microarc oxidation (voltage 350v
frequency 800hz) for 15 seconds
Microarc oxidation produces a titania film with a porous structure
and micropores of 1-5microm
The mechanism of osseointegration of the oxidized implants has
been shown to be mechanical interlocking and biochemical
bonding
Surface coating Ti Plasma Spray
Porous rough Ti surface have been fabricated by plasma
spraying a Ti powder form of molten droplets at high temperature
at temperature in order of 15000C at 600ms
The Ti plasma spray after solidification often provides 004 ndash 005
mm thickness
Ti A spray has been reported to increase the surface area of bone
to implant interface (as much as 600) and stimulate adhesion
osteogenesis
Advantages
Enhance attachment by increasing ionic interactions
Increased load bearing capability by 25-30
Increased tensile strength through ingrowth of bony tissues into 3D feature
Disadvantages
Cracking and scaling of coating because of stresses produced by elevated temprature processing
Risk of accumulation of abraded material in the interface zone during implantation of TPS
Hydroxyapatite coatings
Hydroxyapatite [Ca10(PO4)6OH]2 coating was brought to the
dental profession by DeGroot
HA forms a strong chemical bond with bone due to the presence
of free calcium and phosphate compounds at the implant surface
The HA coating consists of amorphous and crystalline forms with
a large density of cracks
The top 1-2 microm of the HA layer being amorphous while the rest
of the crystalline layer is hexagonally packed
Indicated Fresh extraction sites
Newly grafted sites
Advantages
1 Protection of surrounding bone against metal ion release from the
substrate
2 Reported chemical bonding between HA and living bone-intimate
contact-biointegration
3 Partial dissolution of HA makes surrounding fluid rich in calcium
and phosphate ions which trigger cellular differentiation and bone
formation
Disadvantages
Induction of impurities due to thermal decomposition during
processing- affecting long term clinical fixation
Dissolution of HA at lower pH
HA coating on the implant surface (50-70microm) by various methods
1 Plasma spraying
2 The vacuum deposition technique(ion beam sputtering radiofrequency
sputtering)
3 The sol gel and dip coating method
4 Electrolytic process
Nanotitania coatings
Nanotitania coatings were prepared by using the sol-gel
technique
Nanotitania implants had an increased feature density and a large
feature coverage area as compared to the nano-HA implants
This could present more binding sites for the protein cell
attachment and for increased bone contact
he Nanotitania implants exhibited an ordered arrangement
forming a homogenous layer on underlying topography
Biologically active drugs incorporated dental
implants
Bisphosphonates Bisphosphate-loaded implant surfaces have
been reported to improve implant osseointegration
Simvastatin
Simvastatin could induce the expression of bone morphogenetic
protein (BMP) mRNA that might promote bone formation and
increase bone mineral density
Gentamycin along with the layer of HA can be coated onto the
implant surface which may act as a local prophylactic agent along
with the systemic antibiotics in dental implant surgery
Biochemical Methods
of the Surface
Modifications
Biochemical Methods of the Surface
Modifications
Their goal is to immobilize proteins enzymes or peptides on
biomaterials for the purpose of inducing specific cell and tissue
responses
1 One approach uses cell-adhesion molecules like fibronectin
vitronectin Type I collagen osteogenin and bone sialoprotein
2 The second approach uses biomolecules with osteotropic
effects which range from mitogenicity (interleukin growth
factor-I FGF-2 platelet derived growth factor ndashBB) to the
increasing activity of the bone cells which enhances the
collagen synthesis for osteoinduction
Zirconia implants
Zirconia (Zr02) is a ceramic material used in implantology because
Biocompatibility(bio inert)
Esthetics (because its colour is similar to the teeth) and
Mechanical properties which are better than alumina
High resistance to corrosion flexion and fracture
Contact with bone and soft tissue similar to that observed in
titanium implants
It can be used to produce a entire implant or as a coating
Advantages of Zirconia Dental Implants
No dark colour of the metal showing through the gums
No corrosion of the zirconia as with titanium
No piezo-electric currents between dissimilar metal in
the mouth
It is thermally non-conductive
Greater BIC (Bone ndash Implant Contact)
20 more bone apposition than titanium implants
Zeynep Ouml zkurt Zirconia Dental Implants A Literature Review Journal of Oral Implantology Vol 37(3)2011
RTQ (removal torque testing) Gahlert et al evaluated the RTQ values of
machined zirconia implants sandblasted zirconia implants and SLA titanium
implants The mean RTQ for machined zirconia implants was 259 Ncm the
mean RTQ for zirconia rough implants was 405 Ncm and the mean RTQ for
SLA titanium implants was 1052 Ncm
Fracture strength within clinically acceptable limits
Stress analysis Kohal et al observed the stress distribution patterns of
zirconia implants (ReImplant) which were found to have low well distributed
and similar stress distribution compared with titanium implants
PEEK implants (poly etheretherketone)
These implants are available in three fundamentally different
designs
TAU Diameter -48 mm lengths 10 125 15 mm
immediate loading possible
Low density bone
THETA Similar to TAU but D1 bone
IOTA It is a 3mm diameter implant (10 and 12 mm)
used in narrow ridges
Advantages
Good strengthfracture resistance and bioinertness
Promotes human oseteoblast cell growth
Disadvantages
Faintly radiopaque ndashdifficult for post-op evaluation
Lengths and diameters range is restricted
Advances in
commercially
available implant
systems
LASER- LOK TECHNOLOGY
Unique surface characteristics
Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using
laser ablation technology
Extremely consistent microchannels that are optimally
sized to attach and organize both osteoblasts and
fibroblasts
Includes a repeating nanostructure that maximizes
surface area and enables cell pseudopodia and collagen
microfibrils to interdigitate with the Laser-Lok surface
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
The abutment head generally has a 5 degree taper which makes it
optimal for retention of cement retained prostheses
Only one drill a 15 mm or 2 mm twist drill is required for
placement of the implants
Advantages
Provisionalisation of fully and partially edentulous jaws
Undisturbed healing of bone grafts
Effective way to generate aesthetic transitional appliances
Allows evaluation of phonetics and function
Cost effective
One ndash Piece Implants
The implant is machined from a piece of titanium that
incorporates both the implant body and an integral fixed abutment
in a single component
3 diameters -35 43 and 5 mm
4 lengths -10 13 15 and 16 mm
Clinical and radiographic evaluation of one-piece implants
used for immediate function
Jack a Hahn journal of oral implantology vol 33(3)2007
The aim of the present research was to evaluate the radiographic
outcome of a 1-piece implant when used for immediate function in
an ordinary patient pool
Forty-seven NobelDirect and NobelPerfect 1-piece implants
(Nobel Biocare Goumlteborg Sweden) were placed in maxillae and
mandibles
In this study 1 of the 47 implants had to be removed resulting in a
cumulative implant survival rate of 979 throughout the follow-up
period
The mean marginal bone level relative to the reference point after
1 year of loading (078 - 160 mm) as well as after 2 and 3 years of
loading was located above the first implant thread
In this study a bone level 2 mm apical to the reference point after
1 year of loading was observed at 2 implants (6)
The 1-piece implant design enables undisturbed healing
of the peri-implant soft tissue and avoids disruption of the
soft tissue seal when placing the definitive prosthetic
restoration
Annibali et al reported a series of patients treated
consecutively for first molar replacement according to
Immediate = group 1
Early = group 2
Late = Group 3
The implant survival rate
917 for early implants
950 for immediate post-extraction implants
100 for implants placed in healed sites
Short Dental Implants
A dental implant with length of 7 mm or less (Friberg et al 2000)
Any implant under 10 mm in length referred to as a lsquolsquoshortrsquorsquo
implant (Griffin TJ Cheung WS 2004)
A device with an intra-bony length of 8 mm or less (Renouard
and Nisand 2006)
Indication
Atropic Jaw
Proximity to vital structure
Single crowns
Overdentures
Advantages
1 Bone grafting for height often unnecessary
2 Less money pain and time prior to restoration of the implant
3 Simplified bone surgery
4 Implant insertion easier
Goodacre et al in 2003 reviewed
2754 implants - lt10 mm
3015 implants - gt10 mm in length
The failure rate of implants 10 mm or less was 10 compared
to a 3 failure rate of implants longer than 10 mm
Ivanoff et al in 1999 found an 8-mm-long 5-mm-diameter
implant failed 25 of the time in the maxilla and 33 of the
time in the mandible On the other hand the 10-mm and 12-
mm implants that were 5 mm in diameter reported no
mandibular failure and a 10 failure in the maxilla
Misch CE Short Dental Implants A Literature Review and Rationale for Use Dent Today 2005 Aug24(8)64-6 68
On the other hand a retrospective report by Misch et al was compiled
from 2 private offices using a square thread implant body design
(BioHorizons) rather than a v-shaped thread as primarily reported in the
previous literature
During a 3-year period 126 patients received implants less than 10 mm
long
Of the 437 implants there were 3 implant failures in the posterior
mandible and 1 failure in the posterior maxilla (99 survival)
All these failures were implants 9 mm long and 4 mm in diameter
Advances in Implant materials
Previously implants had macro-irregularities like macroscopic
threads fenestrations pores grooves steps threads or other
surface irregularities that were visible
However difficulty in achieving initial stability post implantation
relative motion adverse interfacial bone remodelling all lead to
search for improvement of the surface quality of a titanium dental
implant
BLASTING
Blasting -aluminium oxide titanium oxide and calcium phosphate
with particle size ranging from small medium to large (150- 350
microm)
Blasting a smooth Ti surface with Al2 O3 particles of 25 microm 75 microm
or 250 microm produces surfaces with roughness values of 116 to 120
143 and 194 to 220 respectively
A series of investigations have demonstrated a firmer bone
fixation of the implant with an average surface roughness (sa) of 1-
15microm than those of smoother implants with an average surface
roughness of 06microm
Blasting and Acid Etching
Acid etching can be done by using an HCL H2 SO4 mixture or by
pickling in 2 HF10HNO3 These processes leave pits and craters
Alumina or TiO2 for blasting the surface
Small - 25μm
large grit -025-05mm
medium grit - 250-500μm
Sand blasted and acid etched surfaces have a hydrophobic surface
The etching leads to the formation of Titanium hydrides and the
replacement of hydride by oxygen results in the slow transformation of
the implant surface resulting in nanometre sized particles of titanium on
the surface which helps in protein adhesion on implant surface
Dual acid etching with HCl and H2SO4 heated above 100ᴼC has
produced surface topography able to attach to fibrin scaffold and
promote adhesion of osteogenic cells
Sand blasting and etching can increase the rate and amount of the
bone formation
Flouride Surface Treatments
This treatment enhances osseointegration and osteoblastic
differentitation with increased expression of Cbfa1 osterix and
bone sialoprotein
Fluoridated rough implants also withstood greater push-out
forces and showed a significantly higher removal torque than
control implants
However detrimental effect of F on the corrosion resistance of
titanium and titanium alloys has been extensively reported
Anodized Surface Implants
Anodized surface implants are implants which are placed as anodes
in galvanic cells with phosphoric acid as the electrolyte and current is
passed through them ndash also ca ldquoTiunite surfacerdquo
The surface oxides grow from the native state of 5nm to
approximately 10000nm
The sa of TiUnite is reported to be 11microm and its sdr 37
Anodic oxidation results in the growth of a native titanium oxide
layer and a porous topography with the bone formation occurring
directly on the moderately rough oxidized surface
Clinical and Radiographic Evaluation of Braringnemark Implants with an
Anodized Surface following Seven-to-Eight Years of Functional Loading
David Gelb Bradley McaAllister et al Int J Dent 2013 2013 583567
The aim of this study was to evaluate the clinical and
radiographic long-term outcomes of dental implants with an
anodized TiUnite surface placed in routine clinical practice
38 single prosthesis
22 FPDs
80 implants in maxilla
27 in mandible
Mean marginal bone level change-149 plusmn 103 mm
907 of cases- no visible plaque93 -visible plaque
No prosthetic complication
Calandriello evaluated immediately placed anodized
implants in 33 patients and found a mean marginal bone
loss of 117thinspmm after 5 years
Friberg and Jemt compared 280 TiUnite implants to 110
machined implants in 111 patients and found marginal
bone loss after 5 years to be 075 and 06thinspmm respectively
with no significant difference between the two types of
implants
Laser etching and Micro Arc Oxidation
After the implants are ultrasonically cleaned they are laser etched
by using an NdYAG laser at a power of 50kw frequency of 75khz
and 164A current
They are then processed in an electrolyte solution with 35
glyceroposphate disodium salt pentahydrate and 12 calcium
acetate monohydrate by microarc oxidation (voltage 350v
frequency 800hz) for 15 seconds
Microarc oxidation produces a titania film with a porous structure
and micropores of 1-5microm
The mechanism of osseointegration of the oxidized implants has
been shown to be mechanical interlocking and biochemical
bonding
Surface coating Ti Plasma Spray
Porous rough Ti surface have been fabricated by plasma
spraying a Ti powder form of molten droplets at high temperature
at temperature in order of 15000C at 600ms
The Ti plasma spray after solidification often provides 004 ndash 005
mm thickness
Ti A spray has been reported to increase the surface area of bone
to implant interface (as much as 600) and stimulate adhesion
osteogenesis
Advantages
Enhance attachment by increasing ionic interactions
Increased load bearing capability by 25-30
Increased tensile strength through ingrowth of bony tissues into 3D feature
Disadvantages
Cracking and scaling of coating because of stresses produced by elevated temprature processing
Risk of accumulation of abraded material in the interface zone during implantation of TPS
Hydroxyapatite coatings
Hydroxyapatite [Ca10(PO4)6OH]2 coating was brought to the
dental profession by DeGroot
HA forms a strong chemical bond with bone due to the presence
of free calcium and phosphate compounds at the implant surface
The HA coating consists of amorphous and crystalline forms with
a large density of cracks
The top 1-2 microm of the HA layer being amorphous while the rest
of the crystalline layer is hexagonally packed
Indicated Fresh extraction sites
Newly grafted sites
Advantages
1 Protection of surrounding bone against metal ion release from the
substrate
2 Reported chemical bonding between HA and living bone-intimate
contact-biointegration
3 Partial dissolution of HA makes surrounding fluid rich in calcium
and phosphate ions which trigger cellular differentiation and bone
formation
Disadvantages
Induction of impurities due to thermal decomposition during
processing- affecting long term clinical fixation
Dissolution of HA at lower pH
HA coating on the implant surface (50-70microm) by various methods
1 Plasma spraying
2 The vacuum deposition technique(ion beam sputtering radiofrequency
sputtering)
3 The sol gel and dip coating method
4 Electrolytic process
Nanotitania coatings
Nanotitania coatings were prepared by using the sol-gel
technique
Nanotitania implants had an increased feature density and a large
feature coverage area as compared to the nano-HA implants
This could present more binding sites for the protein cell
attachment and for increased bone contact
he Nanotitania implants exhibited an ordered arrangement
forming a homogenous layer on underlying topography
Biologically active drugs incorporated dental
implants
Bisphosphonates Bisphosphate-loaded implant surfaces have
been reported to improve implant osseointegration
Simvastatin
Simvastatin could induce the expression of bone morphogenetic
protein (BMP) mRNA that might promote bone formation and
increase bone mineral density
Gentamycin along with the layer of HA can be coated onto the
implant surface which may act as a local prophylactic agent along
with the systemic antibiotics in dental implant surgery
Biochemical Methods
of the Surface
Modifications
Biochemical Methods of the Surface
Modifications
Their goal is to immobilize proteins enzymes or peptides on
biomaterials for the purpose of inducing specific cell and tissue
responses
1 One approach uses cell-adhesion molecules like fibronectin
vitronectin Type I collagen osteogenin and bone sialoprotein
2 The second approach uses biomolecules with osteotropic
effects which range from mitogenicity (interleukin growth
factor-I FGF-2 platelet derived growth factor ndashBB) to the
increasing activity of the bone cells which enhances the
collagen synthesis for osteoinduction
Zirconia implants
Zirconia (Zr02) is a ceramic material used in implantology because
Biocompatibility(bio inert)
Esthetics (because its colour is similar to the teeth) and
Mechanical properties which are better than alumina
High resistance to corrosion flexion and fracture
Contact with bone and soft tissue similar to that observed in
titanium implants
It can be used to produce a entire implant or as a coating
Advantages of Zirconia Dental Implants
No dark colour of the metal showing through the gums
No corrosion of the zirconia as with titanium
No piezo-electric currents between dissimilar metal in
the mouth
It is thermally non-conductive
Greater BIC (Bone ndash Implant Contact)
20 more bone apposition than titanium implants
Zeynep Ouml zkurt Zirconia Dental Implants A Literature Review Journal of Oral Implantology Vol 37(3)2011
RTQ (removal torque testing) Gahlert et al evaluated the RTQ values of
machined zirconia implants sandblasted zirconia implants and SLA titanium
implants The mean RTQ for machined zirconia implants was 259 Ncm the
mean RTQ for zirconia rough implants was 405 Ncm and the mean RTQ for
SLA titanium implants was 1052 Ncm
Fracture strength within clinically acceptable limits
Stress analysis Kohal et al observed the stress distribution patterns of
zirconia implants (ReImplant) which were found to have low well distributed
and similar stress distribution compared with titanium implants
PEEK implants (poly etheretherketone)
These implants are available in three fundamentally different
designs
TAU Diameter -48 mm lengths 10 125 15 mm
immediate loading possible
Low density bone
THETA Similar to TAU but D1 bone
IOTA It is a 3mm diameter implant (10 and 12 mm)
used in narrow ridges
Advantages
Good strengthfracture resistance and bioinertness
Promotes human oseteoblast cell growth
Disadvantages
Faintly radiopaque ndashdifficult for post-op evaluation
Lengths and diameters range is restricted
Advances in
commercially
available implant
systems
LASER- LOK TECHNOLOGY
Unique surface characteristics
Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using
laser ablation technology
Extremely consistent microchannels that are optimally
sized to attach and organize both osteoblasts and
fibroblasts
Includes a repeating nanostructure that maximizes
surface area and enables cell pseudopodia and collagen
microfibrils to interdigitate with the Laser-Lok surface
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
One ndash Piece Implants
The implant is machined from a piece of titanium that
incorporates both the implant body and an integral fixed abutment
in a single component
3 diameters -35 43 and 5 mm
4 lengths -10 13 15 and 16 mm
Clinical and radiographic evaluation of one-piece implants
used for immediate function
Jack a Hahn journal of oral implantology vol 33(3)2007
The aim of the present research was to evaluate the radiographic
outcome of a 1-piece implant when used for immediate function in
an ordinary patient pool
Forty-seven NobelDirect and NobelPerfect 1-piece implants
(Nobel Biocare Goumlteborg Sweden) were placed in maxillae and
mandibles
In this study 1 of the 47 implants had to be removed resulting in a
cumulative implant survival rate of 979 throughout the follow-up
period
The mean marginal bone level relative to the reference point after
1 year of loading (078 - 160 mm) as well as after 2 and 3 years of
loading was located above the first implant thread
In this study a bone level 2 mm apical to the reference point after
1 year of loading was observed at 2 implants (6)
The 1-piece implant design enables undisturbed healing
of the peri-implant soft tissue and avoids disruption of the
soft tissue seal when placing the definitive prosthetic
restoration
Annibali et al reported a series of patients treated
consecutively for first molar replacement according to
Immediate = group 1
Early = group 2
Late = Group 3
The implant survival rate
917 for early implants
950 for immediate post-extraction implants
100 for implants placed in healed sites
Short Dental Implants
A dental implant with length of 7 mm or less (Friberg et al 2000)
Any implant under 10 mm in length referred to as a lsquolsquoshortrsquorsquo
implant (Griffin TJ Cheung WS 2004)
A device with an intra-bony length of 8 mm or less (Renouard
and Nisand 2006)
Indication
Atropic Jaw
Proximity to vital structure
Single crowns
Overdentures
Advantages
1 Bone grafting for height often unnecessary
2 Less money pain and time prior to restoration of the implant
3 Simplified bone surgery
4 Implant insertion easier
Goodacre et al in 2003 reviewed
2754 implants - lt10 mm
3015 implants - gt10 mm in length
The failure rate of implants 10 mm or less was 10 compared
to a 3 failure rate of implants longer than 10 mm
Ivanoff et al in 1999 found an 8-mm-long 5-mm-diameter
implant failed 25 of the time in the maxilla and 33 of the
time in the mandible On the other hand the 10-mm and 12-
mm implants that were 5 mm in diameter reported no
mandibular failure and a 10 failure in the maxilla
Misch CE Short Dental Implants A Literature Review and Rationale for Use Dent Today 2005 Aug24(8)64-6 68
On the other hand a retrospective report by Misch et al was compiled
from 2 private offices using a square thread implant body design
(BioHorizons) rather than a v-shaped thread as primarily reported in the
previous literature
During a 3-year period 126 patients received implants less than 10 mm
long
Of the 437 implants there were 3 implant failures in the posterior
mandible and 1 failure in the posterior maxilla (99 survival)
All these failures were implants 9 mm long and 4 mm in diameter
Advances in Implant materials
Previously implants had macro-irregularities like macroscopic
threads fenestrations pores grooves steps threads or other
surface irregularities that were visible
However difficulty in achieving initial stability post implantation
relative motion adverse interfacial bone remodelling all lead to
search for improvement of the surface quality of a titanium dental
implant
BLASTING
Blasting -aluminium oxide titanium oxide and calcium phosphate
with particle size ranging from small medium to large (150- 350
microm)
Blasting a smooth Ti surface with Al2 O3 particles of 25 microm 75 microm
or 250 microm produces surfaces with roughness values of 116 to 120
143 and 194 to 220 respectively
A series of investigations have demonstrated a firmer bone
fixation of the implant with an average surface roughness (sa) of 1-
15microm than those of smoother implants with an average surface
roughness of 06microm
Blasting and Acid Etching
Acid etching can be done by using an HCL H2 SO4 mixture or by
pickling in 2 HF10HNO3 These processes leave pits and craters
Alumina or TiO2 for blasting the surface
Small - 25μm
large grit -025-05mm
medium grit - 250-500μm
Sand blasted and acid etched surfaces have a hydrophobic surface
The etching leads to the formation of Titanium hydrides and the
replacement of hydride by oxygen results in the slow transformation of
the implant surface resulting in nanometre sized particles of titanium on
the surface which helps in protein adhesion on implant surface
Dual acid etching with HCl and H2SO4 heated above 100ᴼC has
produced surface topography able to attach to fibrin scaffold and
promote adhesion of osteogenic cells
Sand blasting and etching can increase the rate and amount of the
bone formation
Flouride Surface Treatments
This treatment enhances osseointegration and osteoblastic
differentitation with increased expression of Cbfa1 osterix and
bone sialoprotein
Fluoridated rough implants also withstood greater push-out
forces and showed a significantly higher removal torque than
control implants
However detrimental effect of F on the corrosion resistance of
titanium and titanium alloys has been extensively reported
Anodized Surface Implants
Anodized surface implants are implants which are placed as anodes
in galvanic cells with phosphoric acid as the electrolyte and current is
passed through them ndash also ca ldquoTiunite surfacerdquo
The surface oxides grow from the native state of 5nm to
approximately 10000nm
The sa of TiUnite is reported to be 11microm and its sdr 37
Anodic oxidation results in the growth of a native titanium oxide
layer and a porous topography with the bone formation occurring
directly on the moderately rough oxidized surface
Clinical and Radiographic Evaluation of Braringnemark Implants with an
Anodized Surface following Seven-to-Eight Years of Functional Loading
David Gelb Bradley McaAllister et al Int J Dent 2013 2013 583567
The aim of this study was to evaluate the clinical and
radiographic long-term outcomes of dental implants with an
anodized TiUnite surface placed in routine clinical practice
38 single prosthesis
22 FPDs
80 implants in maxilla
27 in mandible
Mean marginal bone level change-149 plusmn 103 mm
907 of cases- no visible plaque93 -visible plaque
No prosthetic complication
Calandriello evaluated immediately placed anodized
implants in 33 patients and found a mean marginal bone
loss of 117thinspmm after 5 years
Friberg and Jemt compared 280 TiUnite implants to 110
machined implants in 111 patients and found marginal
bone loss after 5 years to be 075 and 06thinspmm respectively
with no significant difference between the two types of
implants
Laser etching and Micro Arc Oxidation
After the implants are ultrasonically cleaned they are laser etched
by using an NdYAG laser at a power of 50kw frequency of 75khz
and 164A current
They are then processed in an electrolyte solution with 35
glyceroposphate disodium salt pentahydrate and 12 calcium
acetate monohydrate by microarc oxidation (voltage 350v
frequency 800hz) for 15 seconds
Microarc oxidation produces a titania film with a porous structure
and micropores of 1-5microm
The mechanism of osseointegration of the oxidized implants has
been shown to be mechanical interlocking and biochemical
bonding
Surface coating Ti Plasma Spray
Porous rough Ti surface have been fabricated by plasma
spraying a Ti powder form of molten droplets at high temperature
at temperature in order of 15000C at 600ms
The Ti plasma spray after solidification often provides 004 ndash 005
mm thickness
Ti A spray has been reported to increase the surface area of bone
to implant interface (as much as 600) and stimulate adhesion
osteogenesis
Advantages
Enhance attachment by increasing ionic interactions
Increased load bearing capability by 25-30
Increased tensile strength through ingrowth of bony tissues into 3D feature
Disadvantages
Cracking and scaling of coating because of stresses produced by elevated temprature processing
Risk of accumulation of abraded material in the interface zone during implantation of TPS
Hydroxyapatite coatings
Hydroxyapatite [Ca10(PO4)6OH]2 coating was brought to the
dental profession by DeGroot
HA forms a strong chemical bond with bone due to the presence
of free calcium and phosphate compounds at the implant surface
The HA coating consists of amorphous and crystalline forms with
a large density of cracks
The top 1-2 microm of the HA layer being amorphous while the rest
of the crystalline layer is hexagonally packed
Indicated Fresh extraction sites
Newly grafted sites
Advantages
1 Protection of surrounding bone against metal ion release from the
substrate
2 Reported chemical bonding between HA and living bone-intimate
contact-biointegration
3 Partial dissolution of HA makes surrounding fluid rich in calcium
and phosphate ions which trigger cellular differentiation and bone
formation
Disadvantages
Induction of impurities due to thermal decomposition during
processing- affecting long term clinical fixation
Dissolution of HA at lower pH
HA coating on the implant surface (50-70microm) by various methods
1 Plasma spraying
2 The vacuum deposition technique(ion beam sputtering radiofrequency
sputtering)
3 The sol gel and dip coating method
4 Electrolytic process
Nanotitania coatings
Nanotitania coatings were prepared by using the sol-gel
technique
Nanotitania implants had an increased feature density and a large
feature coverage area as compared to the nano-HA implants
This could present more binding sites for the protein cell
attachment and for increased bone contact
he Nanotitania implants exhibited an ordered arrangement
forming a homogenous layer on underlying topography
Biologically active drugs incorporated dental
implants
Bisphosphonates Bisphosphate-loaded implant surfaces have
been reported to improve implant osseointegration
Simvastatin
Simvastatin could induce the expression of bone morphogenetic
protein (BMP) mRNA that might promote bone formation and
increase bone mineral density
Gentamycin along with the layer of HA can be coated onto the
implant surface which may act as a local prophylactic agent along
with the systemic antibiotics in dental implant surgery
Biochemical Methods
of the Surface
Modifications
Biochemical Methods of the Surface
Modifications
Their goal is to immobilize proteins enzymes or peptides on
biomaterials for the purpose of inducing specific cell and tissue
responses
1 One approach uses cell-adhesion molecules like fibronectin
vitronectin Type I collagen osteogenin and bone sialoprotein
2 The second approach uses biomolecules with osteotropic
effects which range from mitogenicity (interleukin growth
factor-I FGF-2 platelet derived growth factor ndashBB) to the
increasing activity of the bone cells which enhances the
collagen synthesis for osteoinduction
Zirconia implants
Zirconia (Zr02) is a ceramic material used in implantology because
Biocompatibility(bio inert)
Esthetics (because its colour is similar to the teeth) and
Mechanical properties which are better than alumina
High resistance to corrosion flexion and fracture
Contact with bone and soft tissue similar to that observed in
titanium implants
It can be used to produce a entire implant or as a coating
Advantages of Zirconia Dental Implants
No dark colour of the metal showing through the gums
No corrosion of the zirconia as with titanium
No piezo-electric currents between dissimilar metal in
the mouth
It is thermally non-conductive
Greater BIC (Bone ndash Implant Contact)
20 more bone apposition than titanium implants
Zeynep Ouml zkurt Zirconia Dental Implants A Literature Review Journal of Oral Implantology Vol 37(3)2011
RTQ (removal torque testing) Gahlert et al evaluated the RTQ values of
machined zirconia implants sandblasted zirconia implants and SLA titanium
implants The mean RTQ for machined zirconia implants was 259 Ncm the
mean RTQ for zirconia rough implants was 405 Ncm and the mean RTQ for
SLA titanium implants was 1052 Ncm
Fracture strength within clinically acceptable limits
Stress analysis Kohal et al observed the stress distribution patterns of
zirconia implants (ReImplant) which were found to have low well distributed
and similar stress distribution compared with titanium implants
PEEK implants (poly etheretherketone)
These implants are available in three fundamentally different
designs
TAU Diameter -48 mm lengths 10 125 15 mm
immediate loading possible
Low density bone
THETA Similar to TAU but D1 bone
IOTA It is a 3mm diameter implant (10 and 12 mm)
used in narrow ridges
Advantages
Good strengthfracture resistance and bioinertness
Promotes human oseteoblast cell growth
Disadvantages
Faintly radiopaque ndashdifficult for post-op evaluation
Lengths and diameters range is restricted
Advances in
commercially
available implant
systems
LASER- LOK TECHNOLOGY
Unique surface characteristics
Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using
laser ablation technology
Extremely consistent microchannels that are optimally
sized to attach and organize both osteoblasts and
fibroblasts
Includes a repeating nanostructure that maximizes
surface area and enables cell pseudopodia and collagen
microfibrils to interdigitate with the Laser-Lok surface
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Clinical and radiographic evaluation of one-piece implants
used for immediate function
Jack a Hahn journal of oral implantology vol 33(3)2007
The aim of the present research was to evaluate the radiographic
outcome of a 1-piece implant when used for immediate function in
an ordinary patient pool
Forty-seven NobelDirect and NobelPerfect 1-piece implants
(Nobel Biocare Goumlteborg Sweden) were placed in maxillae and
mandibles
In this study 1 of the 47 implants had to be removed resulting in a
cumulative implant survival rate of 979 throughout the follow-up
period
The mean marginal bone level relative to the reference point after
1 year of loading (078 - 160 mm) as well as after 2 and 3 years of
loading was located above the first implant thread
In this study a bone level 2 mm apical to the reference point after
1 year of loading was observed at 2 implants (6)
The 1-piece implant design enables undisturbed healing
of the peri-implant soft tissue and avoids disruption of the
soft tissue seal when placing the definitive prosthetic
restoration
Annibali et al reported a series of patients treated
consecutively for first molar replacement according to
Immediate = group 1
Early = group 2
Late = Group 3
The implant survival rate
917 for early implants
950 for immediate post-extraction implants
100 for implants placed in healed sites
Short Dental Implants
A dental implant with length of 7 mm or less (Friberg et al 2000)
Any implant under 10 mm in length referred to as a lsquolsquoshortrsquorsquo
implant (Griffin TJ Cheung WS 2004)
A device with an intra-bony length of 8 mm or less (Renouard
and Nisand 2006)
Indication
Atropic Jaw
Proximity to vital structure
Single crowns
Overdentures
Advantages
1 Bone grafting for height often unnecessary
2 Less money pain and time prior to restoration of the implant
3 Simplified bone surgery
4 Implant insertion easier
Goodacre et al in 2003 reviewed
2754 implants - lt10 mm
3015 implants - gt10 mm in length
The failure rate of implants 10 mm or less was 10 compared
to a 3 failure rate of implants longer than 10 mm
Ivanoff et al in 1999 found an 8-mm-long 5-mm-diameter
implant failed 25 of the time in the maxilla and 33 of the
time in the mandible On the other hand the 10-mm and 12-
mm implants that were 5 mm in diameter reported no
mandibular failure and a 10 failure in the maxilla
Misch CE Short Dental Implants A Literature Review and Rationale for Use Dent Today 2005 Aug24(8)64-6 68
On the other hand a retrospective report by Misch et al was compiled
from 2 private offices using a square thread implant body design
(BioHorizons) rather than a v-shaped thread as primarily reported in the
previous literature
During a 3-year period 126 patients received implants less than 10 mm
long
Of the 437 implants there were 3 implant failures in the posterior
mandible and 1 failure in the posterior maxilla (99 survival)
All these failures were implants 9 mm long and 4 mm in diameter
Advances in Implant materials
Previously implants had macro-irregularities like macroscopic
threads fenestrations pores grooves steps threads or other
surface irregularities that were visible
However difficulty in achieving initial stability post implantation
relative motion adverse interfacial bone remodelling all lead to
search for improvement of the surface quality of a titanium dental
implant
BLASTING
Blasting -aluminium oxide titanium oxide and calcium phosphate
with particle size ranging from small medium to large (150- 350
microm)
Blasting a smooth Ti surface with Al2 O3 particles of 25 microm 75 microm
or 250 microm produces surfaces with roughness values of 116 to 120
143 and 194 to 220 respectively
A series of investigations have demonstrated a firmer bone
fixation of the implant with an average surface roughness (sa) of 1-
15microm than those of smoother implants with an average surface
roughness of 06microm
Blasting and Acid Etching
Acid etching can be done by using an HCL H2 SO4 mixture or by
pickling in 2 HF10HNO3 These processes leave pits and craters
Alumina or TiO2 for blasting the surface
Small - 25μm
large grit -025-05mm
medium grit - 250-500μm
Sand blasted and acid etched surfaces have a hydrophobic surface
The etching leads to the formation of Titanium hydrides and the
replacement of hydride by oxygen results in the slow transformation of
the implant surface resulting in nanometre sized particles of titanium on
the surface which helps in protein adhesion on implant surface
Dual acid etching with HCl and H2SO4 heated above 100ᴼC has
produced surface topography able to attach to fibrin scaffold and
promote adhesion of osteogenic cells
Sand blasting and etching can increase the rate and amount of the
bone formation
Flouride Surface Treatments
This treatment enhances osseointegration and osteoblastic
differentitation with increased expression of Cbfa1 osterix and
bone sialoprotein
Fluoridated rough implants also withstood greater push-out
forces and showed a significantly higher removal torque than
control implants
However detrimental effect of F on the corrosion resistance of
titanium and titanium alloys has been extensively reported
Anodized Surface Implants
Anodized surface implants are implants which are placed as anodes
in galvanic cells with phosphoric acid as the electrolyte and current is
passed through them ndash also ca ldquoTiunite surfacerdquo
The surface oxides grow from the native state of 5nm to
approximately 10000nm
The sa of TiUnite is reported to be 11microm and its sdr 37
Anodic oxidation results in the growth of a native titanium oxide
layer and a porous topography with the bone formation occurring
directly on the moderately rough oxidized surface
Clinical and Radiographic Evaluation of Braringnemark Implants with an
Anodized Surface following Seven-to-Eight Years of Functional Loading
David Gelb Bradley McaAllister et al Int J Dent 2013 2013 583567
The aim of this study was to evaluate the clinical and
radiographic long-term outcomes of dental implants with an
anodized TiUnite surface placed in routine clinical practice
38 single prosthesis
22 FPDs
80 implants in maxilla
27 in mandible
Mean marginal bone level change-149 plusmn 103 mm
907 of cases- no visible plaque93 -visible plaque
No prosthetic complication
Calandriello evaluated immediately placed anodized
implants in 33 patients and found a mean marginal bone
loss of 117thinspmm after 5 years
Friberg and Jemt compared 280 TiUnite implants to 110
machined implants in 111 patients and found marginal
bone loss after 5 years to be 075 and 06thinspmm respectively
with no significant difference between the two types of
implants
Laser etching and Micro Arc Oxidation
After the implants are ultrasonically cleaned they are laser etched
by using an NdYAG laser at a power of 50kw frequency of 75khz
and 164A current
They are then processed in an electrolyte solution with 35
glyceroposphate disodium salt pentahydrate and 12 calcium
acetate monohydrate by microarc oxidation (voltage 350v
frequency 800hz) for 15 seconds
Microarc oxidation produces a titania film with a porous structure
and micropores of 1-5microm
The mechanism of osseointegration of the oxidized implants has
been shown to be mechanical interlocking and biochemical
bonding
Surface coating Ti Plasma Spray
Porous rough Ti surface have been fabricated by plasma
spraying a Ti powder form of molten droplets at high temperature
at temperature in order of 15000C at 600ms
The Ti plasma spray after solidification often provides 004 ndash 005
mm thickness
Ti A spray has been reported to increase the surface area of bone
to implant interface (as much as 600) and stimulate adhesion
osteogenesis
Advantages
Enhance attachment by increasing ionic interactions
Increased load bearing capability by 25-30
Increased tensile strength through ingrowth of bony tissues into 3D feature
Disadvantages
Cracking and scaling of coating because of stresses produced by elevated temprature processing
Risk of accumulation of abraded material in the interface zone during implantation of TPS
Hydroxyapatite coatings
Hydroxyapatite [Ca10(PO4)6OH]2 coating was brought to the
dental profession by DeGroot
HA forms a strong chemical bond with bone due to the presence
of free calcium and phosphate compounds at the implant surface
The HA coating consists of amorphous and crystalline forms with
a large density of cracks
The top 1-2 microm of the HA layer being amorphous while the rest
of the crystalline layer is hexagonally packed
Indicated Fresh extraction sites
Newly grafted sites
Advantages
1 Protection of surrounding bone against metal ion release from the
substrate
2 Reported chemical bonding between HA and living bone-intimate
contact-biointegration
3 Partial dissolution of HA makes surrounding fluid rich in calcium
and phosphate ions which trigger cellular differentiation and bone
formation
Disadvantages
Induction of impurities due to thermal decomposition during
processing- affecting long term clinical fixation
Dissolution of HA at lower pH
HA coating on the implant surface (50-70microm) by various methods
1 Plasma spraying
2 The vacuum deposition technique(ion beam sputtering radiofrequency
sputtering)
3 The sol gel and dip coating method
4 Electrolytic process
Nanotitania coatings
Nanotitania coatings were prepared by using the sol-gel
technique
Nanotitania implants had an increased feature density and a large
feature coverage area as compared to the nano-HA implants
This could present more binding sites for the protein cell
attachment and for increased bone contact
he Nanotitania implants exhibited an ordered arrangement
forming a homogenous layer on underlying topography
Biologically active drugs incorporated dental
implants
Bisphosphonates Bisphosphate-loaded implant surfaces have
been reported to improve implant osseointegration
Simvastatin
Simvastatin could induce the expression of bone morphogenetic
protein (BMP) mRNA that might promote bone formation and
increase bone mineral density
Gentamycin along with the layer of HA can be coated onto the
implant surface which may act as a local prophylactic agent along
with the systemic antibiotics in dental implant surgery
Biochemical Methods
of the Surface
Modifications
Biochemical Methods of the Surface
Modifications
Their goal is to immobilize proteins enzymes or peptides on
biomaterials for the purpose of inducing specific cell and tissue
responses
1 One approach uses cell-adhesion molecules like fibronectin
vitronectin Type I collagen osteogenin and bone sialoprotein
2 The second approach uses biomolecules with osteotropic
effects which range from mitogenicity (interleukin growth
factor-I FGF-2 platelet derived growth factor ndashBB) to the
increasing activity of the bone cells which enhances the
collagen synthesis for osteoinduction
Zirconia implants
Zirconia (Zr02) is a ceramic material used in implantology because
Biocompatibility(bio inert)
Esthetics (because its colour is similar to the teeth) and
Mechanical properties which are better than alumina
High resistance to corrosion flexion and fracture
Contact with bone and soft tissue similar to that observed in
titanium implants
It can be used to produce a entire implant or as a coating
Advantages of Zirconia Dental Implants
No dark colour of the metal showing through the gums
No corrosion of the zirconia as with titanium
No piezo-electric currents between dissimilar metal in
the mouth
It is thermally non-conductive
Greater BIC (Bone ndash Implant Contact)
20 more bone apposition than titanium implants
Zeynep Ouml zkurt Zirconia Dental Implants A Literature Review Journal of Oral Implantology Vol 37(3)2011
RTQ (removal torque testing) Gahlert et al evaluated the RTQ values of
machined zirconia implants sandblasted zirconia implants and SLA titanium
implants The mean RTQ for machined zirconia implants was 259 Ncm the
mean RTQ for zirconia rough implants was 405 Ncm and the mean RTQ for
SLA titanium implants was 1052 Ncm
Fracture strength within clinically acceptable limits
Stress analysis Kohal et al observed the stress distribution patterns of
zirconia implants (ReImplant) which were found to have low well distributed
and similar stress distribution compared with titanium implants
PEEK implants (poly etheretherketone)
These implants are available in three fundamentally different
designs
TAU Diameter -48 mm lengths 10 125 15 mm
immediate loading possible
Low density bone
THETA Similar to TAU but D1 bone
IOTA It is a 3mm diameter implant (10 and 12 mm)
used in narrow ridges
Advantages
Good strengthfracture resistance and bioinertness
Promotes human oseteoblast cell growth
Disadvantages
Faintly radiopaque ndashdifficult for post-op evaluation
Lengths and diameters range is restricted
Advances in
commercially
available implant
systems
LASER- LOK TECHNOLOGY
Unique surface characteristics
Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using
laser ablation technology
Extremely consistent microchannels that are optimally
sized to attach and organize both osteoblasts and
fibroblasts
Includes a repeating nanostructure that maximizes
surface area and enables cell pseudopodia and collagen
microfibrils to interdigitate with the Laser-Lok surface
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
In this study 1 of the 47 implants had to be removed resulting in a
cumulative implant survival rate of 979 throughout the follow-up
period
The mean marginal bone level relative to the reference point after
1 year of loading (078 - 160 mm) as well as after 2 and 3 years of
loading was located above the first implant thread
In this study a bone level 2 mm apical to the reference point after
1 year of loading was observed at 2 implants (6)
The 1-piece implant design enables undisturbed healing
of the peri-implant soft tissue and avoids disruption of the
soft tissue seal when placing the definitive prosthetic
restoration
Annibali et al reported a series of patients treated
consecutively for first molar replacement according to
Immediate = group 1
Early = group 2
Late = Group 3
The implant survival rate
917 for early implants
950 for immediate post-extraction implants
100 for implants placed in healed sites
Short Dental Implants
A dental implant with length of 7 mm or less (Friberg et al 2000)
Any implant under 10 mm in length referred to as a lsquolsquoshortrsquorsquo
implant (Griffin TJ Cheung WS 2004)
A device with an intra-bony length of 8 mm or less (Renouard
and Nisand 2006)
Indication
Atropic Jaw
Proximity to vital structure
Single crowns
Overdentures
Advantages
1 Bone grafting for height often unnecessary
2 Less money pain and time prior to restoration of the implant
3 Simplified bone surgery
4 Implant insertion easier
Goodacre et al in 2003 reviewed
2754 implants - lt10 mm
3015 implants - gt10 mm in length
The failure rate of implants 10 mm or less was 10 compared
to a 3 failure rate of implants longer than 10 mm
Ivanoff et al in 1999 found an 8-mm-long 5-mm-diameter
implant failed 25 of the time in the maxilla and 33 of the
time in the mandible On the other hand the 10-mm and 12-
mm implants that were 5 mm in diameter reported no
mandibular failure and a 10 failure in the maxilla
Misch CE Short Dental Implants A Literature Review and Rationale for Use Dent Today 2005 Aug24(8)64-6 68
On the other hand a retrospective report by Misch et al was compiled
from 2 private offices using a square thread implant body design
(BioHorizons) rather than a v-shaped thread as primarily reported in the
previous literature
During a 3-year period 126 patients received implants less than 10 mm
long
Of the 437 implants there were 3 implant failures in the posterior
mandible and 1 failure in the posterior maxilla (99 survival)
All these failures were implants 9 mm long and 4 mm in diameter
Advances in Implant materials
Previously implants had macro-irregularities like macroscopic
threads fenestrations pores grooves steps threads or other
surface irregularities that were visible
However difficulty in achieving initial stability post implantation
relative motion adverse interfacial bone remodelling all lead to
search for improvement of the surface quality of a titanium dental
implant
BLASTING
Blasting -aluminium oxide titanium oxide and calcium phosphate
with particle size ranging from small medium to large (150- 350
microm)
Blasting a smooth Ti surface with Al2 O3 particles of 25 microm 75 microm
or 250 microm produces surfaces with roughness values of 116 to 120
143 and 194 to 220 respectively
A series of investigations have demonstrated a firmer bone
fixation of the implant with an average surface roughness (sa) of 1-
15microm than those of smoother implants with an average surface
roughness of 06microm
Blasting and Acid Etching
Acid etching can be done by using an HCL H2 SO4 mixture or by
pickling in 2 HF10HNO3 These processes leave pits and craters
Alumina or TiO2 for blasting the surface
Small - 25μm
large grit -025-05mm
medium grit - 250-500μm
Sand blasted and acid etched surfaces have a hydrophobic surface
The etching leads to the formation of Titanium hydrides and the
replacement of hydride by oxygen results in the slow transformation of
the implant surface resulting in nanometre sized particles of titanium on
the surface which helps in protein adhesion on implant surface
Dual acid etching with HCl and H2SO4 heated above 100ᴼC has
produced surface topography able to attach to fibrin scaffold and
promote adhesion of osteogenic cells
Sand blasting and etching can increase the rate and amount of the
bone formation
Flouride Surface Treatments
This treatment enhances osseointegration and osteoblastic
differentitation with increased expression of Cbfa1 osterix and
bone sialoprotein
Fluoridated rough implants also withstood greater push-out
forces and showed a significantly higher removal torque than
control implants
However detrimental effect of F on the corrosion resistance of
titanium and titanium alloys has been extensively reported
Anodized Surface Implants
Anodized surface implants are implants which are placed as anodes
in galvanic cells with phosphoric acid as the electrolyte and current is
passed through them ndash also ca ldquoTiunite surfacerdquo
The surface oxides grow from the native state of 5nm to
approximately 10000nm
The sa of TiUnite is reported to be 11microm and its sdr 37
Anodic oxidation results in the growth of a native titanium oxide
layer and a porous topography with the bone formation occurring
directly on the moderately rough oxidized surface
Clinical and Radiographic Evaluation of Braringnemark Implants with an
Anodized Surface following Seven-to-Eight Years of Functional Loading
David Gelb Bradley McaAllister et al Int J Dent 2013 2013 583567
The aim of this study was to evaluate the clinical and
radiographic long-term outcomes of dental implants with an
anodized TiUnite surface placed in routine clinical practice
38 single prosthesis
22 FPDs
80 implants in maxilla
27 in mandible
Mean marginal bone level change-149 plusmn 103 mm
907 of cases- no visible plaque93 -visible plaque
No prosthetic complication
Calandriello evaluated immediately placed anodized
implants in 33 patients and found a mean marginal bone
loss of 117thinspmm after 5 years
Friberg and Jemt compared 280 TiUnite implants to 110
machined implants in 111 patients and found marginal
bone loss after 5 years to be 075 and 06thinspmm respectively
with no significant difference between the two types of
implants
Laser etching and Micro Arc Oxidation
After the implants are ultrasonically cleaned they are laser etched
by using an NdYAG laser at a power of 50kw frequency of 75khz
and 164A current
They are then processed in an electrolyte solution with 35
glyceroposphate disodium salt pentahydrate and 12 calcium
acetate monohydrate by microarc oxidation (voltage 350v
frequency 800hz) for 15 seconds
Microarc oxidation produces a titania film with a porous structure
and micropores of 1-5microm
The mechanism of osseointegration of the oxidized implants has
been shown to be mechanical interlocking and biochemical
bonding
Surface coating Ti Plasma Spray
Porous rough Ti surface have been fabricated by plasma
spraying a Ti powder form of molten droplets at high temperature
at temperature in order of 15000C at 600ms
The Ti plasma spray after solidification often provides 004 ndash 005
mm thickness
Ti A spray has been reported to increase the surface area of bone
to implant interface (as much as 600) and stimulate adhesion
osteogenesis
Advantages
Enhance attachment by increasing ionic interactions
Increased load bearing capability by 25-30
Increased tensile strength through ingrowth of bony tissues into 3D feature
Disadvantages
Cracking and scaling of coating because of stresses produced by elevated temprature processing
Risk of accumulation of abraded material in the interface zone during implantation of TPS
Hydroxyapatite coatings
Hydroxyapatite [Ca10(PO4)6OH]2 coating was brought to the
dental profession by DeGroot
HA forms a strong chemical bond with bone due to the presence
of free calcium and phosphate compounds at the implant surface
The HA coating consists of amorphous and crystalline forms with
a large density of cracks
The top 1-2 microm of the HA layer being amorphous while the rest
of the crystalline layer is hexagonally packed
Indicated Fresh extraction sites
Newly grafted sites
Advantages
1 Protection of surrounding bone against metal ion release from the
substrate
2 Reported chemical bonding between HA and living bone-intimate
contact-biointegration
3 Partial dissolution of HA makes surrounding fluid rich in calcium
and phosphate ions which trigger cellular differentiation and bone
formation
Disadvantages
Induction of impurities due to thermal decomposition during
processing- affecting long term clinical fixation
Dissolution of HA at lower pH
HA coating on the implant surface (50-70microm) by various methods
1 Plasma spraying
2 The vacuum deposition technique(ion beam sputtering radiofrequency
sputtering)
3 The sol gel and dip coating method
4 Electrolytic process
Nanotitania coatings
Nanotitania coatings were prepared by using the sol-gel
technique
Nanotitania implants had an increased feature density and a large
feature coverage area as compared to the nano-HA implants
This could present more binding sites for the protein cell
attachment and for increased bone contact
he Nanotitania implants exhibited an ordered arrangement
forming a homogenous layer on underlying topography
Biologically active drugs incorporated dental
implants
Bisphosphonates Bisphosphate-loaded implant surfaces have
been reported to improve implant osseointegration
Simvastatin
Simvastatin could induce the expression of bone morphogenetic
protein (BMP) mRNA that might promote bone formation and
increase bone mineral density
Gentamycin along with the layer of HA can be coated onto the
implant surface which may act as a local prophylactic agent along
with the systemic antibiotics in dental implant surgery
Biochemical Methods
of the Surface
Modifications
Biochemical Methods of the Surface
Modifications
Their goal is to immobilize proteins enzymes or peptides on
biomaterials for the purpose of inducing specific cell and tissue
responses
1 One approach uses cell-adhesion molecules like fibronectin
vitronectin Type I collagen osteogenin and bone sialoprotein
2 The second approach uses biomolecules with osteotropic
effects which range from mitogenicity (interleukin growth
factor-I FGF-2 platelet derived growth factor ndashBB) to the
increasing activity of the bone cells which enhances the
collagen synthesis for osteoinduction
Zirconia implants
Zirconia (Zr02) is a ceramic material used in implantology because
Biocompatibility(bio inert)
Esthetics (because its colour is similar to the teeth) and
Mechanical properties which are better than alumina
High resistance to corrosion flexion and fracture
Contact with bone and soft tissue similar to that observed in
titanium implants
It can be used to produce a entire implant or as a coating
Advantages of Zirconia Dental Implants
No dark colour of the metal showing through the gums
No corrosion of the zirconia as with titanium
No piezo-electric currents between dissimilar metal in
the mouth
It is thermally non-conductive
Greater BIC (Bone ndash Implant Contact)
20 more bone apposition than titanium implants
Zeynep Ouml zkurt Zirconia Dental Implants A Literature Review Journal of Oral Implantology Vol 37(3)2011
RTQ (removal torque testing) Gahlert et al evaluated the RTQ values of
machined zirconia implants sandblasted zirconia implants and SLA titanium
implants The mean RTQ for machined zirconia implants was 259 Ncm the
mean RTQ for zirconia rough implants was 405 Ncm and the mean RTQ for
SLA titanium implants was 1052 Ncm
Fracture strength within clinically acceptable limits
Stress analysis Kohal et al observed the stress distribution patterns of
zirconia implants (ReImplant) which were found to have low well distributed
and similar stress distribution compared with titanium implants
PEEK implants (poly etheretherketone)
These implants are available in three fundamentally different
designs
TAU Diameter -48 mm lengths 10 125 15 mm
immediate loading possible
Low density bone
THETA Similar to TAU but D1 bone
IOTA It is a 3mm diameter implant (10 and 12 mm)
used in narrow ridges
Advantages
Good strengthfracture resistance and bioinertness
Promotes human oseteoblast cell growth
Disadvantages
Faintly radiopaque ndashdifficult for post-op evaluation
Lengths and diameters range is restricted
Advances in
commercially
available implant
systems
LASER- LOK TECHNOLOGY
Unique surface characteristics
Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using
laser ablation technology
Extremely consistent microchannels that are optimally
sized to attach and organize both osteoblasts and
fibroblasts
Includes a repeating nanostructure that maximizes
surface area and enables cell pseudopodia and collagen
microfibrils to interdigitate with the Laser-Lok surface
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
The 1-piece implant design enables undisturbed healing
of the peri-implant soft tissue and avoids disruption of the
soft tissue seal when placing the definitive prosthetic
restoration
Annibali et al reported a series of patients treated
consecutively for first molar replacement according to
Immediate = group 1
Early = group 2
Late = Group 3
The implant survival rate
917 for early implants
950 for immediate post-extraction implants
100 for implants placed in healed sites
Short Dental Implants
A dental implant with length of 7 mm or less (Friberg et al 2000)
Any implant under 10 mm in length referred to as a lsquolsquoshortrsquorsquo
implant (Griffin TJ Cheung WS 2004)
A device with an intra-bony length of 8 mm or less (Renouard
and Nisand 2006)
Indication
Atropic Jaw
Proximity to vital structure
Single crowns
Overdentures
Advantages
1 Bone grafting for height often unnecessary
2 Less money pain and time prior to restoration of the implant
3 Simplified bone surgery
4 Implant insertion easier
Goodacre et al in 2003 reviewed
2754 implants - lt10 mm
3015 implants - gt10 mm in length
The failure rate of implants 10 mm or less was 10 compared
to a 3 failure rate of implants longer than 10 mm
Ivanoff et al in 1999 found an 8-mm-long 5-mm-diameter
implant failed 25 of the time in the maxilla and 33 of the
time in the mandible On the other hand the 10-mm and 12-
mm implants that were 5 mm in diameter reported no
mandibular failure and a 10 failure in the maxilla
Misch CE Short Dental Implants A Literature Review and Rationale for Use Dent Today 2005 Aug24(8)64-6 68
On the other hand a retrospective report by Misch et al was compiled
from 2 private offices using a square thread implant body design
(BioHorizons) rather than a v-shaped thread as primarily reported in the
previous literature
During a 3-year period 126 patients received implants less than 10 mm
long
Of the 437 implants there were 3 implant failures in the posterior
mandible and 1 failure in the posterior maxilla (99 survival)
All these failures were implants 9 mm long and 4 mm in diameter
Advances in Implant materials
Previously implants had macro-irregularities like macroscopic
threads fenestrations pores grooves steps threads or other
surface irregularities that were visible
However difficulty in achieving initial stability post implantation
relative motion adverse interfacial bone remodelling all lead to
search for improvement of the surface quality of a titanium dental
implant
BLASTING
Blasting -aluminium oxide titanium oxide and calcium phosphate
with particle size ranging from small medium to large (150- 350
microm)
Blasting a smooth Ti surface with Al2 O3 particles of 25 microm 75 microm
or 250 microm produces surfaces with roughness values of 116 to 120
143 and 194 to 220 respectively
A series of investigations have demonstrated a firmer bone
fixation of the implant with an average surface roughness (sa) of 1-
15microm than those of smoother implants with an average surface
roughness of 06microm
Blasting and Acid Etching
Acid etching can be done by using an HCL H2 SO4 mixture or by
pickling in 2 HF10HNO3 These processes leave pits and craters
Alumina or TiO2 for blasting the surface
Small - 25μm
large grit -025-05mm
medium grit - 250-500μm
Sand blasted and acid etched surfaces have a hydrophobic surface
The etching leads to the formation of Titanium hydrides and the
replacement of hydride by oxygen results in the slow transformation of
the implant surface resulting in nanometre sized particles of titanium on
the surface which helps in protein adhesion on implant surface
Dual acid etching with HCl and H2SO4 heated above 100ᴼC has
produced surface topography able to attach to fibrin scaffold and
promote adhesion of osteogenic cells
Sand blasting and etching can increase the rate and amount of the
bone formation
Flouride Surface Treatments
This treatment enhances osseointegration and osteoblastic
differentitation with increased expression of Cbfa1 osterix and
bone sialoprotein
Fluoridated rough implants also withstood greater push-out
forces and showed a significantly higher removal torque than
control implants
However detrimental effect of F on the corrosion resistance of
titanium and titanium alloys has been extensively reported
Anodized Surface Implants
Anodized surface implants are implants which are placed as anodes
in galvanic cells with phosphoric acid as the electrolyte and current is
passed through them ndash also ca ldquoTiunite surfacerdquo
The surface oxides grow from the native state of 5nm to
approximately 10000nm
The sa of TiUnite is reported to be 11microm and its sdr 37
Anodic oxidation results in the growth of a native titanium oxide
layer and a porous topography with the bone formation occurring
directly on the moderately rough oxidized surface
Clinical and Radiographic Evaluation of Braringnemark Implants with an
Anodized Surface following Seven-to-Eight Years of Functional Loading
David Gelb Bradley McaAllister et al Int J Dent 2013 2013 583567
The aim of this study was to evaluate the clinical and
radiographic long-term outcomes of dental implants with an
anodized TiUnite surface placed in routine clinical practice
38 single prosthesis
22 FPDs
80 implants in maxilla
27 in mandible
Mean marginal bone level change-149 plusmn 103 mm
907 of cases- no visible plaque93 -visible plaque
No prosthetic complication
Calandriello evaluated immediately placed anodized
implants in 33 patients and found a mean marginal bone
loss of 117thinspmm after 5 years
Friberg and Jemt compared 280 TiUnite implants to 110
machined implants in 111 patients and found marginal
bone loss after 5 years to be 075 and 06thinspmm respectively
with no significant difference between the two types of
implants
Laser etching and Micro Arc Oxidation
After the implants are ultrasonically cleaned they are laser etched
by using an NdYAG laser at a power of 50kw frequency of 75khz
and 164A current
They are then processed in an electrolyte solution with 35
glyceroposphate disodium salt pentahydrate and 12 calcium
acetate monohydrate by microarc oxidation (voltage 350v
frequency 800hz) for 15 seconds
Microarc oxidation produces a titania film with a porous structure
and micropores of 1-5microm
The mechanism of osseointegration of the oxidized implants has
been shown to be mechanical interlocking and biochemical
bonding
Surface coating Ti Plasma Spray
Porous rough Ti surface have been fabricated by plasma
spraying a Ti powder form of molten droplets at high temperature
at temperature in order of 15000C at 600ms
The Ti plasma spray after solidification often provides 004 ndash 005
mm thickness
Ti A spray has been reported to increase the surface area of bone
to implant interface (as much as 600) and stimulate adhesion
osteogenesis
Advantages
Enhance attachment by increasing ionic interactions
Increased load bearing capability by 25-30
Increased tensile strength through ingrowth of bony tissues into 3D feature
Disadvantages
Cracking and scaling of coating because of stresses produced by elevated temprature processing
Risk of accumulation of abraded material in the interface zone during implantation of TPS
Hydroxyapatite coatings
Hydroxyapatite [Ca10(PO4)6OH]2 coating was brought to the
dental profession by DeGroot
HA forms a strong chemical bond with bone due to the presence
of free calcium and phosphate compounds at the implant surface
The HA coating consists of amorphous and crystalline forms with
a large density of cracks
The top 1-2 microm of the HA layer being amorphous while the rest
of the crystalline layer is hexagonally packed
Indicated Fresh extraction sites
Newly grafted sites
Advantages
1 Protection of surrounding bone against metal ion release from the
substrate
2 Reported chemical bonding between HA and living bone-intimate
contact-biointegration
3 Partial dissolution of HA makes surrounding fluid rich in calcium
and phosphate ions which trigger cellular differentiation and bone
formation
Disadvantages
Induction of impurities due to thermal decomposition during
processing- affecting long term clinical fixation
Dissolution of HA at lower pH
HA coating on the implant surface (50-70microm) by various methods
1 Plasma spraying
2 The vacuum deposition technique(ion beam sputtering radiofrequency
sputtering)
3 The sol gel and dip coating method
4 Electrolytic process
Nanotitania coatings
Nanotitania coatings were prepared by using the sol-gel
technique
Nanotitania implants had an increased feature density and a large
feature coverage area as compared to the nano-HA implants
This could present more binding sites for the protein cell
attachment and for increased bone contact
he Nanotitania implants exhibited an ordered arrangement
forming a homogenous layer on underlying topography
Biologically active drugs incorporated dental
implants
Bisphosphonates Bisphosphate-loaded implant surfaces have
been reported to improve implant osseointegration
Simvastatin
Simvastatin could induce the expression of bone morphogenetic
protein (BMP) mRNA that might promote bone formation and
increase bone mineral density
Gentamycin along with the layer of HA can be coated onto the
implant surface which may act as a local prophylactic agent along
with the systemic antibiotics in dental implant surgery
Biochemical Methods
of the Surface
Modifications
Biochemical Methods of the Surface
Modifications
Their goal is to immobilize proteins enzymes or peptides on
biomaterials for the purpose of inducing specific cell and tissue
responses
1 One approach uses cell-adhesion molecules like fibronectin
vitronectin Type I collagen osteogenin and bone sialoprotein
2 The second approach uses biomolecules with osteotropic
effects which range from mitogenicity (interleukin growth
factor-I FGF-2 platelet derived growth factor ndashBB) to the
increasing activity of the bone cells which enhances the
collagen synthesis for osteoinduction
Zirconia implants
Zirconia (Zr02) is a ceramic material used in implantology because
Biocompatibility(bio inert)
Esthetics (because its colour is similar to the teeth) and
Mechanical properties which are better than alumina
High resistance to corrosion flexion and fracture
Contact with bone and soft tissue similar to that observed in
titanium implants
It can be used to produce a entire implant or as a coating
Advantages of Zirconia Dental Implants
No dark colour of the metal showing through the gums
No corrosion of the zirconia as with titanium
No piezo-electric currents between dissimilar metal in
the mouth
It is thermally non-conductive
Greater BIC (Bone ndash Implant Contact)
20 more bone apposition than titanium implants
Zeynep Ouml zkurt Zirconia Dental Implants A Literature Review Journal of Oral Implantology Vol 37(3)2011
RTQ (removal torque testing) Gahlert et al evaluated the RTQ values of
machined zirconia implants sandblasted zirconia implants and SLA titanium
implants The mean RTQ for machined zirconia implants was 259 Ncm the
mean RTQ for zirconia rough implants was 405 Ncm and the mean RTQ for
SLA titanium implants was 1052 Ncm
Fracture strength within clinically acceptable limits
Stress analysis Kohal et al observed the stress distribution patterns of
zirconia implants (ReImplant) which were found to have low well distributed
and similar stress distribution compared with titanium implants
PEEK implants (poly etheretherketone)
These implants are available in three fundamentally different
designs
TAU Diameter -48 mm lengths 10 125 15 mm
immediate loading possible
Low density bone
THETA Similar to TAU but D1 bone
IOTA It is a 3mm diameter implant (10 and 12 mm)
used in narrow ridges
Advantages
Good strengthfracture resistance and bioinertness
Promotes human oseteoblast cell growth
Disadvantages
Faintly radiopaque ndashdifficult for post-op evaluation
Lengths and diameters range is restricted
Advances in
commercially
available implant
systems
LASER- LOK TECHNOLOGY
Unique surface characteristics
Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using
laser ablation technology
Extremely consistent microchannels that are optimally
sized to attach and organize both osteoblasts and
fibroblasts
Includes a repeating nanostructure that maximizes
surface area and enables cell pseudopodia and collagen
microfibrils to interdigitate with the Laser-Lok surface
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Short Dental Implants
A dental implant with length of 7 mm or less (Friberg et al 2000)
Any implant under 10 mm in length referred to as a lsquolsquoshortrsquorsquo
implant (Griffin TJ Cheung WS 2004)
A device with an intra-bony length of 8 mm or less (Renouard
and Nisand 2006)
Indication
Atropic Jaw
Proximity to vital structure
Single crowns
Overdentures
Advantages
1 Bone grafting for height often unnecessary
2 Less money pain and time prior to restoration of the implant
3 Simplified bone surgery
4 Implant insertion easier
Goodacre et al in 2003 reviewed
2754 implants - lt10 mm
3015 implants - gt10 mm in length
The failure rate of implants 10 mm or less was 10 compared
to a 3 failure rate of implants longer than 10 mm
Ivanoff et al in 1999 found an 8-mm-long 5-mm-diameter
implant failed 25 of the time in the maxilla and 33 of the
time in the mandible On the other hand the 10-mm and 12-
mm implants that were 5 mm in diameter reported no
mandibular failure and a 10 failure in the maxilla
Misch CE Short Dental Implants A Literature Review and Rationale for Use Dent Today 2005 Aug24(8)64-6 68
On the other hand a retrospective report by Misch et al was compiled
from 2 private offices using a square thread implant body design
(BioHorizons) rather than a v-shaped thread as primarily reported in the
previous literature
During a 3-year period 126 patients received implants less than 10 mm
long
Of the 437 implants there were 3 implant failures in the posterior
mandible and 1 failure in the posterior maxilla (99 survival)
All these failures were implants 9 mm long and 4 mm in diameter
Advances in Implant materials
Previously implants had macro-irregularities like macroscopic
threads fenestrations pores grooves steps threads or other
surface irregularities that were visible
However difficulty in achieving initial stability post implantation
relative motion adverse interfacial bone remodelling all lead to
search for improvement of the surface quality of a titanium dental
implant
BLASTING
Blasting -aluminium oxide titanium oxide and calcium phosphate
with particle size ranging from small medium to large (150- 350
microm)
Blasting a smooth Ti surface with Al2 O3 particles of 25 microm 75 microm
or 250 microm produces surfaces with roughness values of 116 to 120
143 and 194 to 220 respectively
A series of investigations have demonstrated a firmer bone
fixation of the implant with an average surface roughness (sa) of 1-
15microm than those of smoother implants with an average surface
roughness of 06microm
Blasting and Acid Etching
Acid etching can be done by using an HCL H2 SO4 mixture or by
pickling in 2 HF10HNO3 These processes leave pits and craters
Alumina or TiO2 for blasting the surface
Small - 25μm
large grit -025-05mm
medium grit - 250-500μm
Sand blasted and acid etched surfaces have a hydrophobic surface
The etching leads to the formation of Titanium hydrides and the
replacement of hydride by oxygen results in the slow transformation of
the implant surface resulting in nanometre sized particles of titanium on
the surface which helps in protein adhesion on implant surface
Dual acid etching with HCl and H2SO4 heated above 100ᴼC has
produced surface topography able to attach to fibrin scaffold and
promote adhesion of osteogenic cells
Sand blasting and etching can increase the rate and amount of the
bone formation
Flouride Surface Treatments
This treatment enhances osseointegration and osteoblastic
differentitation with increased expression of Cbfa1 osterix and
bone sialoprotein
Fluoridated rough implants also withstood greater push-out
forces and showed a significantly higher removal torque than
control implants
However detrimental effect of F on the corrosion resistance of
titanium and titanium alloys has been extensively reported
Anodized Surface Implants
Anodized surface implants are implants which are placed as anodes
in galvanic cells with phosphoric acid as the electrolyte and current is
passed through them ndash also ca ldquoTiunite surfacerdquo
The surface oxides grow from the native state of 5nm to
approximately 10000nm
The sa of TiUnite is reported to be 11microm and its sdr 37
Anodic oxidation results in the growth of a native titanium oxide
layer and a porous topography with the bone formation occurring
directly on the moderately rough oxidized surface
Clinical and Radiographic Evaluation of Braringnemark Implants with an
Anodized Surface following Seven-to-Eight Years of Functional Loading
David Gelb Bradley McaAllister et al Int J Dent 2013 2013 583567
The aim of this study was to evaluate the clinical and
radiographic long-term outcomes of dental implants with an
anodized TiUnite surface placed in routine clinical practice
38 single prosthesis
22 FPDs
80 implants in maxilla
27 in mandible
Mean marginal bone level change-149 plusmn 103 mm
907 of cases- no visible plaque93 -visible plaque
No prosthetic complication
Calandriello evaluated immediately placed anodized
implants in 33 patients and found a mean marginal bone
loss of 117thinspmm after 5 years
Friberg and Jemt compared 280 TiUnite implants to 110
machined implants in 111 patients and found marginal
bone loss after 5 years to be 075 and 06thinspmm respectively
with no significant difference between the two types of
implants
Laser etching and Micro Arc Oxidation
After the implants are ultrasonically cleaned they are laser etched
by using an NdYAG laser at a power of 50kw frequency of 75khz
and 164A current
They are then processed in an electrolyte solution with 35
glyceroposphate disodium salt pentahydrate and 12 calcium
acetate monohydrate by microarc oxidation (voltage 350v
frequency 800hz) for 15 seconds
Microarc oxidation produces a titania film with a porous structure
and micropores of 1-5microm
The mechanism of osseointegration of the oxidized implants has
been shown to be mechanical interlocking and biochemical
bonding
Surface coating Ti Plasma Spray
Porous rough Ti surface have been fabricated by plasma
spraying a Ti powder form of molten droplets at high temperature
at temperature in order of 15000C at 600ms
The Ti plasma spray after solidification often provides 004 ndash 005
mm thickness
Ti A spray has been reported to increase the surface area of bone
to implant interface (as much as 600) and stimulate adhesion
osteogenesis
Advantages
Enhance attachment by increasing ionic interactions
Increased load bearing capability by 25-30
Increased tensile strength through ingrowth of bony tissues into 3D feature
Disadvantages
Cracking and scaling of coating because of stresses produced by elevated temprature processing
Risk of accumulation of abraded material in the interface zone during implantation of TPS
Hydroxyapatite coatings
Hydroxyapatite [Ca10(PO4)6OH]2 coating was brought to the
dental profession by DeGroot
HA forms a strong chemical bond with bone due to the presence
of free calcium and phosphate compounds at the implant surface
The HA coating consists of amorphous and crystalline forms with
a large density of cracks
The top 1-2 microm of the HA layer being amorphous while the rest
of the crystalline layer is hexagonally packed
Indicated Fresh extraction sites
Newly grafted sites
Advantages
1 Protection of surrounding bone against metal ion release from the
substrate
2 Reported chemical bonding between HA and living bone-intimate
contact-biointegration
3 Partial dissolution of HA makes surrounding fluid rich in calcium
and phosphate ions which trigger cellular differentiation and bone
formation
Disadvantages
Induction of impurities due to thermal decomposition during
processing- affecting long term clinical fixation
Dissolution of HA at lower pH
HA coating on the implant surface (50-70microm) by various methods
1 Plasma spraying
2 The vacuum deposition technique(ion beam sputtering radiofrequency
sputtering)
3 The sol gel and dip coating method
4 Electrolytic process
Nanotitania coatings
Nanotitania coatings were prepared by using the sol-gel
technique
Nanotitania implants had an increased feature density and a large
feature coverage area as compared to the nano-HA implants
This could present more binding sites for the protein cell
attachment and for increased bone contact
he Nanotitania implants exhibited an ordered arrangement
forming a homogenous layer on underlying topography
Biologically active drugs incorporated dental
implants
Bisphosphonates Bisphosphate-loaded implant surfaces have
been reported to improve implant osseointegration
Simvastatin
Simvastatin could induce the expression of bone morphogenetic
protein (BMP) mRNA that might promote bone formation and
increase bone mineral density
Gentamycin along with the layer of HA can be coated onto the
implant surface which may act as a local prophylactic agent along
with the systemic antibiotics in dental implant surgery
Biochemical Methods
of the Surface
Modifications
Biochemical Methods of the Surface
Modifications
Their goal is to immobilize proteins enzymes or peptides on
biomaterials for the purpose of inducing specific cell and tissue
responses
1 One approach uses cell-adhesion molecules like fibronectin
vitronectin Type I collagen osteogenin and bone sialoprotein
2 The second approach uses biomolecules with osteotropic
effects which range from mitogenicity (interleukin growth
factor-I FGF-2 platelet derived growth factor ndashBB) to the
increasing activity of the bone cells which enhances the
collagen synthesis for osteoinduction
Zirconia implants
Zirconia (Zr02) is a ceramic material used in implantology because
Biocompatibility(bio inert)
Esthetics (because its colour is similar to the teeth) and
Mechanical properties which are better than alumina
High resistance to corrosion flexion and fracture
Contact with bone and soft tissue similar to that observed in
titanium implants
It can be used to produce a entire implant or as a coating
Advantages of Zirconia Dental Implants
No dark colour of the metal showing through the gums
No corrosion of the zirconia as with titanium
No piezo-electric currents between dissimilar metal in
the mouth
It is thermally non-conductive
Greater BIC (Bone ndash Implant Contact)
20 more bone apposition than titanium implants
Zeynep Ouml zkurt Zirconia Dental Implants A Literature Review Journal of Oral Implantology Vol 37(3)2011
RTQ (removal torque testing) Gahlert et al evaluated the RTQ values of
machined zirconia implants sandblasted zirconia implants and SLA titanium
implants The mean RTQ for machined zirconia implants was 259 Ncm the
mean RTQ for zirconia rough implants was 405 Ncm and the mean RTQ for
SLA titanium implants was 1052 Ncm
Fracture strength within clinically acceptable limits
Stress analysis Kohal et al observed the stress distribution patterns of
zirconia implants (ReImplant) which were found to have low well distributed
and similar stress distribution compared with titanium implants
PEEK implants (poly etheretherketone)
These implants are available in three fundamentally different
designs
TAU Diameter -48 mm lengths 10 125 15 mm
immediate loading possible
Low density bone
THETA Similar to TAU but D1 bone
IOTA It is a 3mm diameter implant (10 and 12 mm)
used in narrow ridges
Advantages
Good strengthfracture resistance and bioinertness
Promotes human oseteoblast cell growth
Disadvantages
Faintly radiopaque ndashdifficult for post-op evaluation
Lengths and diameters range is restricted
Advances in
commercially
available implant
systems
LASER- LOK TECHNOLOGY
Unique surface characteristics
Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using
laser ablation technology
Extremely consistent microchannels that are optimally
sized to attach and organize both osteoblasts and
fibroblasts
Includes a repeating nanostructure that maximizes
surface area and enables cell pseudopodia and collagen
microfibrils to interdigitate with the Laser-Lok surface
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Advantages
1 Bone grafting for height often unnecessary
2 Less money pain and time prior to restoration of the implant
3 Simplified bone surgery
4 Implant insertion easier
Goodacre et al in 2003 reviewed
2754 implants - lt10 mm
3015 implants - gt10 mm in length
The failure rate of implants 10 mm or less was 10 compared
to a 3 failure rate of implants longer than 10 mm
Ivanoff et al in 1999 found an 8-mm-long 5-mm-diameter
implant failed 25 of the time in the maxilla and 33 of the
time in the mandible On the other hand the 10-mm and 12-
mm implants that were 5 mm in diameter reported no
mandibular failure and a 10 failure in the maxilla
Misch CE Short Dental Implants A Literature Review and Rationale for Use Dent Today 2005 Aug24(8)64-6 68
On the other hand a retrospective report by Misch et al was compiled
from 2 private offices using a square thread implant body design
(BioHorizons) rather than a v-shaped thread as primarily reported in the
previous literature
During a 3-year period 126 patients received implants less than 10 mm
long
Of the 437 implants there were 3 implant failures in the posterior
mandible and 1 failure in the posterior maxilla (99 survival)
All these failures were implants 9 mm long and 4 mm in diameter
Advances in Implant materials
Previously implants had macro-irregularities like macroscopic
threads fenestrations pores grooves steps threads or other
surface irregularities that were visible
However difficulty in achieving initial stability post implantation
relative motion adverse interfacial bone remodelling all lead to
search for improvement of the surface quality of a titanium dental
implant
BLASTING
Blasting -aluminium oxide titanium oxide and calcium phosphate
with particle size ranging from small medium to large (150- 350
microm)
Blasting a smooth Ti surface with Al2 O3 particles of 25 microm 75 microm
or 250 microm produces surfaces with roughness values of 116 to 120
143 and 194 to 220 respectively
A series of investigations have demonstrated a firmer bone
fixation of the implant with an average surface roughness (sa) of 1-
15microm than those of smoother implants with an average surface
roughness of 06microm
Blasting and Acid Etching
Acid etching can be done by using an HCL H2 SO4 mixture or by
pickling in 2 HF10HNO3 These processes leave pits and craters
Alumina or TiO2 for blasting the surface
Small - 25μm
large grit -025-05mm
medium grit - 250-500μm
Sand blasted and acid etched surfaces have a hydrophobic surface
The etching leads to the formation of Titanium hydrides and the
replacement of hydride by oxygen results in the slow transformation of
the implant surface resulting in nanometre sized particles of titanium on
the surface which helps in protein adhesion on implant surface
Dual acid etching with HCl and H2SO4 heated above 100ᴼC has
produced surface topography able to attach to fibrin scaffold and
promote adhesion of osteogenic cells
Sand blasting and etching can increase the rate and amount of the
bone formation
Flouride Surface Treatments
This treatment enhances osseointegration and osteoblastic
differentitation with increased expression of Cbfa1 osterix and
bone sialoprotein
Fluoridated rough implants also withstood greater push-out
forces and showed a significantly higher removal torque than
control implants
However detrimental effect of F on the corrosion resistance of
titanium and titanium alloys has been extensively reported
Anodized Surface Implants
Anodized surface implants are implants which are placed as anodes
in galvanic cells with phosphoric acid as the electrolyte and current is
passed through them ndash also ca ldquoTiunite surfacerdquo
The surface oxides grow from the native state of 5nm to
approximately 10000nm
The sa of TiUnite is reported to be 11microm and its sdr 37
Anodic oxidation results in the growth of a native titanium oxide
layer and a porous topography with the bone formation occurring
directly on the moderately rough oxidized surface
Clinical and Radiographic Evaluation of Braringnemark Implants with an
Anodized Surface following Seven-to-Eight Years of Functional Loading
David Gelb Bradley McaAllister et al Int J Dent 2013 2013 583567
The aim of this study was to evaluate the clinical and
radiographic long-term outcomes of dental implants with an
anodized TiUnite surface placed in routine clinical practice
38 single prosthesis
22 FPDs
80 implants in maxilla
27 in mandible
Mean marginal bone level change-149 plusmn 103 mm
907 of cases- no visible plaque93 -visible plaque
No prosthetic complication
Calandriello evaluated immediately placed anodized
implants in 33 patients and found a mean marginal bone
loss of 117thinspmm after 5 years
Friberg and Jemt compared 280 TiUnite implants to 110
machined implants in 111 patients and found marginal
bone loss after 5 years to be 075 and 06thinspmm respectively
with no significant difference between the two types of
implants
Laser etching and Micro Arc Oxidation
After the implants are ultrasonically cleaned they are laser etched
by using an NdYAG laser at a power of 50kw frequency of 75khz
and 164A current
They are then processed in an electrolyte solution with 35
glyceroposphate disodium salt pentahydrate and 12 calcium
acetate monohydrate by microarc oxidation (voltage 350v
frequency 800hz) for 15 seconds
Microarc oxidation produces a titania film with a porous structure
and micropores of 1-5microm
The mechanism of osseointegration of the oxidized implants has
been shown to be mechanical interlocking and biochemical
bonding
Surface coating Ti Plasma Spray
Porous rough Ti surface have been fabricated by plasma
spraying a Ti powder form of molten droplets at high temperature
at temperature in order of 15000C at 600ms
The Ti plasma spray after solidification often provides 004 ndash 005
mm thickness
Ti A spray has been reported to increase the surface area of bone
to implant interface (as much as 600) and stimulate adhesion
osteogenesis
Advantages
Enhance attachment by increasing ionic interactions
Increased load bearing capability by 25-30
Increased tensile strength through ingrowth of bony tissues into 3D feature
Disadvantages
Cracking and scaling of coating because of stresses produced by elevated temprature processing
Risk of accumulation of abraded material in the interface zone during implantation of TPS
Hydroxyapatite coatings
Hydroxyapatite [Ca10(PO4)6OH]2 coating was brought to the
dental profession by DeGroot
HA forms a strong chemical bond with bone due to the presence
of free calcium and phosphate compounds at the implant surface
The HA coating consists of amorphous and crystalline forms with
a large density of cracks
The top 1-2 microm of the HA layer being amorphous while the rest
of the crystalline layer is hexagonally packed
Indicated Fresh extraction sites
Newly grafted sites
Advantages
1 Protection of surrounding bone against metal ion release from the
substrate
2 Reported chemical bonding between HA and living bone-intimate
contact-biointegration
3 Partial dissolution of HA makes surrounding fluid rich in calcium
and phosphate ions which trigger cellular differentiation and bone
formation
Disadvantages
Induction of impurities due to thermal decomposition during
processing- affecting long term clinical fixation
Dissolution of HA at lower pH
HA coating on the implant surface (50-70microm) by various methods
1 Plasma spraying
2 The vacuum deposition technique(ion beam sputtering radiofrequency
sputtering)
3 The sol gel and dip coating method
4 Electrolytic process
Nanotitania coatings
Nanotitania coatings were prepared by using the sol-gel
technique
Nanotitania implants had an increased feature density and a large
feature coverage area as compared to the nano-HA implants
This could present more binding sites for the protein cell
attachment and for increased bone contact
he Nanotitania implants exhibited an ordered arrangement
forming a homogenous layer on underlying topography
Biologically active drugs incorporated dental
implants
Bisphosphonates Bisphosphate-loaded implant surfaces have
been reported to improve implant osseointegration
Simvastatin
Simvastatin could induce the expression of bone morphogenetic
protein (BMP) mRNA that might promote bone formation and
increase bone mineral density
Gentamycin along with the layer of HA can be coated onto the
implant surface which may act as a local prophylactic agent along
with the systemic antibiotics in dental implant surgery
Biochemical Methods
of the Surface
Modifications
Biochemical Methods of the Surface
Modifications
Their goal is to immobilize proteins enzymes or peptides on
biomaterials for the purpose of inducing specific cell and tissue
responses
1 One approach uses cell-adhesion molecules like fibronectin
vitronectin Type I collagen osteogenin and bone sialoprotein
2 The second approach uses biomolecules with osteotropic
effects which range from mitogenicity (interleukin growth
factor-I FGF-2 platelet derived growth factor ndashBB) to the
increasing activity of the bone cells which enhances the
collagen synthesis for osteoinduction
Zirconia implants
Zirconia (Zr02) is a ceramic material used in implantology because
Biocompatibility(bio inert)
Esthetics (because its colour is similar to the teeth) and
Mechanical properties which are better than alumina
High resistance to corrosion flexion and fracture
Contact with bone and soft tissue similar to that observed in
titanium implants
It can be used to produce a entire implant or as a coating
Advantages of Zirconia Dental Implants
No dark colour of the metal showing through the gums
No corrosion of the zirconia as with titanium
No piezo-electric currents between dissimilar metal in
the mouth
It is thermally non-conductive
Greater BIC (Bone ndash Implant Contact)
20 more bone apposition than titanium implants
Zeynep Ouml zkurt Zirconia Dental Implants A Literature Review Journal of Oral Implantology Vol 37(3)2011
RTQ (removal torque testing) Gahlert et al evaluated the RTQ values of
machined zirconia implants sandblasted zirconia implants and SLA titanium
implants The mean RTQ for machined zirconia implants was 259 Ncm the
mean RTQ for zirconia rough implants was 405 Ncm and the mean RTQ for
SLA titanium implants was 1052 Ncm
Fracture strength within clinically acceptable limits
Stress analysis Kohal et al observed the stress distribution patterns of
zirconia implants (ReImplant) which were found to have low well distributed
and similar stress distribution compared with titanium implants
PEEK implants (poly etheretherketone)
These implants are available in three fundamentally different
designs
TAU Diameter -48 mm lengths 10 125 15 mm
immediate loading possible
Low density bone
THETA Similar to TAU but D1 bone
IOTA It is a 3mm diameter implant (10 and 12 mm)
used in narrow ridges
Advantages
Good strengthfracture resistance and bioinertness
Promotes human oseteoblast cell growth
Disadvantages
Faintly radiopaque ndashdifficult for post-op evaluation
Lengths and diameters range is restricted
Advances in
commercially
available implant
systems
LASER- LOK TECHNOLOGY
Unique surface characteristics
Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using
laser ablation technology
Extremely consistent microchannels that are optimally
sized to attach and organize both osteoblasts and
fibroblasts
Includes a repeating nanostructure that maximizes
surface area and enables cell pseudopodia and collagen
microfibrils to interdigitate with the Laser-Lok surface
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Goodacre et al in 2003 reviewed
2754 implants - lt10 mm
3015 implants - gt10 mm in length
The failure rate of implants 10 mm or less was 10 compared
to a 3 failure rate of implants longer than 10 mm
Ivanoff et al in 1999 found an 8-mm-long 5-mm-diameter
implant failed 25 of the time in the maxilla and 33 of the
time in the mandible On the other hand the 10-mm and 12-
mm implants that were 5 mm in diameter reported no
mandibular failure and a 10 failure in the maxilla
Misch CE Short Dental Implants A Literature Review and Rationale for Use Dent Today 2005 Aug24(8)64-6 68
On the other hand a retrospective report by Misch et al was compiled
from 2 private offices using a square thread implant body design
(BioHorizons) rather than a v-shaped thread as primarily reported in the
previous literature
During a 3-year period 126 patients received implants less than 10 mm
long
Of the 437 implants there were 3 implant failures in the posterior
mandible and 1 failure in the posterior maxilla (99 survival)
All these failures were implants 9 mm long and 4 mm in diameter
Advances in Implant materials
Previously implants had macro-irregularities like macroscopic
threads fenestrations pores grooves steps threads or other
surface irregularities that were visible
However difficulty in achieving initial stability post implantation
relative motion adverse interfacial bone remodelling all lead to
search for improvement of the surface quality of a titanium dental
implant
BLASTING
Blasting -aluminium oxide titanium oxide and calcium phosphate
with particle size ranging from small medium to large (150- 350
microm)
Blasting a smooth Ti surface with Al2 O3 particles of 25 microm 75 microm
or 250 microm produces surfaces with roughness values of 116 to 120
143 and 194 to 220 respectively
A series of investigations have demonstrated a firmer bone
fixation of the implant with an average surface roughness (sa) of 1-
15microm than those of smoother implants with an average surface
roughness of 06microm
Blasting and Acid Etching
Acid etching can be done by using an HCL H2 SO4 mixture or by
pickling in 2 HF10HNO3 These processes leave pits and craters
Alumina or TiO2 for blasting the surface
Small - 25μm
large grit -025-05mm
medium grit - 250-500μm
Sand blasted and acid etched surfaces have a hydrophobic surface
The etching leads to the formation of Titanium hydrides and the
replacement of hydride by oxygen results in the slow transformation of
the implant surface resulting in nanometre sized particles of titanium on
the surface which helps in protein adhesion on implant surface
Dual acid etching with HCl and H2SO4 heated above 100ᴼC has
produced surface topography able to attach to fibrin scaffold and
promote adhesion of osteogenic cells
Sand blasting and etching can increase the rate and amount of the
bone formation
Flouride Surface Treatments
This treatment enhances osseointegration and osteoblastic
differentitation with increased expression of Cbfa1 osterix and
bone sialoprotein
Fluoridated rough implants also withstood greater push-out
forces and showed a significantly higher removal torque than
control implants
However detrimental effect of F on the corrosion resistance of
titanium and titanium alloys has been extensively reported
Anodized Surface Implants
Anodized surface implants are implants which are placed as anodes
in galvanic cells with phosphoric acid as the electrolyte and current is
passed through them ndash also ca ldquoTiunite surfacerdquo
The surface oxides grow from the native state of 5nm to
approximately 10000nm
The sa of TiUnite is reported to be 11microm and its sdr 37
Anodic oxidation results in the growth of a native titanium oxide
layer and a porous topography with the bone formation occurring
directly on the moderately rough oxidized surface
Clinical and Radiographic Evaluation of Braringnemark Implants with an
Anodized Surface following Seven-to-Eight Years of Functional Loading
David Gelb Bradley McaAllister et al Int J Dent 2013 2013 583567
The aim of this study was to evaluate the clinical and
radiographic long-term outcomes of dental implants with an
anodized TiUnite surface placed in routine clinical practice
38 single prosthesis
22 FPDs
80 implants in maxilla
27 in mandible
Mean marginal bone level change-149 plusmn 103 mm
907 of cases- no visible plaque93 -visible plaque
No prosthetic complication
Calandriello evaluated immediately placed anodized
implants in 33 patients and found a mean marginal bone
loss of 117thinspmm after 5 years
Friberg and Jemt compared 280 TiUnite implants to 110
machined implants in 111 patients and found marginal
bone loss after 5 years to be 075 and 06thinspmm respectively
with no significant difference between the two types of
implants
Laser etching and Micro Arc Oxidation
After the implants are ultrasonically cleaned they are laser etched
by using an NdYAG laser at a power of 50kw frequency of 75khz
and 164A current
They are then processed in an electrolyte solution with 35
glyceroposphate disodium salt pentahydrate and 12 calcium
acetate monohydrate by microarc oxidation (voltage 350v
frequency 800hz) for 15 seconds
Microarc oxidation produces a titania film with a porous structure
and micropores of 1-5microm
The mechanism of osseointegration of the oxidized implants has
been shown to be mechanical interlocking and biochemical
bonding
Surface coating Ti Plasma Spray
Porous rough Ti surface have been fabricated by plasma
spraying a Ti powder form of molten droplets at high temperature
at temperature in order of 15000C at 600ms
The Ti plasma spray after solidification often provides 004 ndash 005
mm thickness
Ti A spray has been reported to increase the surface area of bone
to implant interface (as much as 600) and stimulate adhesion
osteogenesis
Advantages
Enhance attachment by increasing ionic interactions
Increased load bearing capability by 25-30
Increased tensile strength through ingrowth of bony tissues into 3D feature
Disadvantages
Cracking and scaling of coating because of stresses produced by elevated temprature processing
Risk of accumulation of abraded material in the interface zone during implantation of TPS
Hydroxyapatite coatings
Hydroxyapatite [Ca10(PO4)6OH]2 coating was brought to the
dental profession by DeGroot
HA forms a strong chemical bond with bone due to the presence
of free calcium and phosphate compounds at the implant surface
The HA coating consists of amorphous and crystalline forms with
a large density of cracks
The top 1-2 microm of the HA layer being amorphous while the rest
of the crystalline layer is hexagonally packed
Indicated Fresh extraction sites
Newly grafted sites
Advantages
1 Protection of surrounding bone against metal ion release from the
substrate
2 Reported chemical bonding between HA and living bone-intimate
contact-biointegration
3 Partial dissolution of HA makes surrounding fluid rich in calcium
and phosphate ions which trigger cellular differentiation and bone
formation
Disadvantages
Induction of impurities due to thermal decomposition during
processing- affecting long term clinical fixation
Dissolution of HA at lower pH
HA coating on the implant surface (50-70microm) by various methods
1 Plasma spraying
2 The vacuum deposition technique(ion beam sputtering radiofrequency
sputtering)
3 The sol gel and dip coating method
4 Electrolytic process
Nanotitania coatings
Nanotitania coatings were prepared by using the sol-gel
technique
Nanotitania implants had an increased feature density and a large
feature coverage area as compared to the nano-HA implants
This could present more binding sites for the protein cell
attachment and for increased bone contact
he Nanotitania implants exhibited an ordered arrangement
forming a homogenous layer on underlying topography
Biologically active drugs incorporated dental
implants
Bisphosphonates Bisphosphate-loaded implant surfaces have
been reported to improve implant osseointegration
Simvastatin
Simvastatin could induce the expression of bone morphogenetic
protein (BMP) mRNA that might promote bone formation and
increase bone mineral density
Gentamycin along with the layer of HA can be coated onto the
implant surface which may act as a local prophylactic agent along
with the systemic antibiotics in dental implant surgery
Biochemical Methods
of the Surface
Modifications
Biochemical Methods of the Surface
Modifications
Their goal is to immobilize proteins enzymes or peptides on
biomaterials for the purpose of inducing specific cell and tissue
responses
1 One approach uses cell-adhesion molecules like fibronectin
vitronectin Type I collagen osteogenin and bone sialoprotein
2 The second approach uses biomolecules with osteotropic
effects which range from mitogenicity (interleukin growth
factor-I FGF-2 platelet derived growth factor ndashBB) to the
increasing activity of the bone cells which enhances the
collagen synthesis for osteoinduction
Zirconia implants
Zirconia (Zr02) is a ceramic material used in implantology because
Biocompatibility(bio inert)
Esthetics (because its colour is similar to the teeth) and
Mechanical properties which are better than alumina
High resistance to corrosion flexion and fracture
Contact with bone and soft tissue similar to that observed in
titanium implants
It can be used to produce a entire implant or as a coating
Advantages of Zirconia Dental Implants
No dark colour of the metal showing through the gums
No corrosion of the zirconia as with titanium
No piezo-electric currents between dissimilar metal in
the mouth
It is thermally non-conductive
Greater BIC (Bone ndash Implant Contact)
20 more bone apposition than titanium implants
Zeynep Ouml zkurt Zirconia Dental Implants A Literature Review Journal of Oral Implantology Vol 37(3)2011
RTQ (removal torque testing) Gahlert et al evaluated the RTQ values of
machined zirconia implants sandblasted zirconia implants and SLA titanium
implants The mean RTQ for machined zirconia implants was 259 Ncm the
mean RTQ for zirconia rough implants was 405 Ncm and the mean RTQ for
SLA titanium implants was 1052 Ncm
Fracture strength within clinically acceptable limits
Stress analysis Kohal et al observed the stress distribution patterns of
zirconia implants (ReImplant) which were found to have low well distributed
and similar stress distribution compared with titanium implants
PEEK implants (poly etheretherketone)
These implants are available in three fundamentally different
designs
TAU Diameter -48 mm lengths 10 125 15 mm
immediate loading possible
Low density bone
THETA Similar to TAU but D1 bone
IOTA It is a 3mm diameter implant (10 and 12 mm)
used in narrow ridges
Advantages
Good strengthfracture resistance and bioinertness
Promotes human oseteoblast cell growth
Disadvantages
Faintly radiopaque ndashdifficult for post-op evaluation
Lengths and diameters range is restricted
Advances in
commercially
available implant
systems
LASER- LOK TECHNOLOGY
Unique surface characteristics
Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using
laser ablation technology
Extremely consistent microchannels that are optimally
sized to attach and organize both osteoblasts and
fibroblasts
Includes a repeating nanostructure that maximizes
surface area and enables cell pseudopodia and collagen
microfibrils to interdigitate with the Laser-Lok surface
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
On the other hand a retrospective report by Misch et al was compiled
from 2 private offices using a square thread implant body design
(BioHorizons) rather than a v-shaped thread as primarily reported in the
previous literature
During a 3-year period 126 patients received implants less than 10 mm
long
Of the 437 implants there were 3 implant failures in the posterior
mandible and 1 failure in the posterior maxilla (99 survival)
All these failures were implants 9 mm long and 4 mm in diameter
Advances in Implant materials
Previously implants had macro-irregularities like macroscopic
threads fenestrations pores grooves steps threads or other
surface irregularities that were visible
However difficulty in achieving initial stability post implantation
relative motion adverse interfacial bone remodelling all lead to
search for improvement of the surface quality of a titanium dental
implant
BLASTING
Blasting -aluminium oxide titanium oxide and calcium phosphate
with particle size ranging from small medium to large (150- 350
microm)
Blasting a smooth Ti surface with Al2 O3 particles of 25 microm 75 microm
or 250 microm produces surfaces with roughness values of 116 to 120
143 and 194 to 220 respectively
A series of investigations have demonstrated a firmer bone
fixation of the implant with an average surface roughness (sa) of 1-
15microm than those of smoother implants with an average surface
roughness of 06microm
Blasting and Acid Etching
Acid etching can be done by using an HCL H2 SO4 mixture or by
pickling in 2 HF10HNO3 These processes leave pits and craters
Alumina or TiO2 for blasting the surface
Small - 25μm
large grit -025-05mm
medium grit - 250-500μm
Sand blasted and acid etched surfaces have a hydrophobic surface
The etching leads to the formation of Titanium hydrides and the
replacement of hydride by oxygen results in the slow transformation of
the implant surface resulting in nanometre sized particles of titanium on
the surface which helps in protein adhesion on implant surface
Dual acid etching with HCl and H2SO4 heated above 100ᴼC has
produced surface topography able to attach to fibrin scaffold and
promote adhesion of osteogenic cells
Sand blasting and etching can increase the rate and amount of the
bone formation
Flouride Surface Treatments
This treatment enhances osseointegration and osteoblastic
differentitation with increased expression of Cbfa1 osterix and
bone sialoprotein
Fluoridated rough implants also withstood greater push-out
forces and showed a significantly higher removal torque than
control implants
However detrimental effect of F on the corrosion resistance of
titanium and titanium alloys has been extensively reported
Anodized Surface Implants
Anodized surface implants are implants which are placed as anodes
in galvanic cells with phosphoric acid as the electrolyte and current is
passed through them ndash also ca ldquoTiunite surfacerdquo
The surface oxides grow from the native state of 5nm to
approximately 10000nm
The sa of TiUnite is reported to be 11microm and its sdr 37
Anodic oxidation results in the growth of a native titanium oxide
layer and a porous topography with the bone formation occurring
directly on the moderately rough oxidized surface
Clinical and Radiographic Evaluation of Braringnemark Implants with an
Anodized Surface following Seven-to-Eight Years of Functional Loading
David Gelb Bradley McaAllister et al Int J Dent 2013 2013 583567
The aim of this study was to evaluate the clinical and
radiographic long-term outcomes of dental implants with an
anodized TiUnite surface placed in routine clinical practice
38 single prosthesis
22 FPDs
80 implants in maxilla
27 in mandible
Mean marginal bone level change-149 plusmn 103 mm
907 of cases- no visible plaque93 -visible plaque
No prosthetic complication
Calandriello evaluated immediately placed anodized
implants in 33 patients and found a mean marginal bone
loss of 117thinspmm after 5 years
Friberg and Jemt compared 280 TiUnite implants to 110
machined implants in 111 patients and found marginal
bone loss after 5 years to be 075 and 06thinspmm respectively
with no significant difference between the two types of
implants
Laser etching and Micro Arc Oxidation
After the implants are ultrasonically cleaned they are laser etched
by using an NdYAG laser at a power of 50kw frequency of 75khz
and 164A current
They are then processed in an electrolyte solution with 35
glyceroposphate disodium salt pentahydrate and 12 calcium
acetate monohydrate by microarc oxidation (voltage 350v
frequency 800hz) for 15 seconds
Microarc oxidation produces a titania film with a porous structure
and micropores of 1-5microm
The mechanism of osseointegration of the oxidized implants has
been shown to be mechanical interlocking and biochemical
bonding
Surface coating Ti Plasma Spray
Porous rough Ti surface have been fabricated by plasma
spraying a Ti powder form of molten droplets at high temperature
at temperature in order of 15000C at 600ms
The Ti plasma spray after solidification often provides 004 ndash 005
mm thickness
Ti A spray has been reported to increase the surface area of bone
to implant interface (as much as 600) and stimulate adhesion
osteogenesis
Advantages
Enhance attachment by increasing ionic interactions
Increased load bearing capability by 25-30
Increased tensile strength through ingrowth of bony tissues into 3D feature
Disadvantages
Cracking and scaling of coating because of stresses produced by elevated temprature processing
Risk of accumulation of abraded material in the interface zone during implantation of TPS
Hydroxyapatite coatings
Hydroxyapatite [Ca10(PO4)6OH]2 coating was brought to the
dental profession by DeGroot
HA forms a strong chemical bond with bone due to the presence
of free calcium and phosphate compounds at the implant surface
The HA coating consists of amorphous and crystalline forms with
a large density of cracks
The top 1-2 microm of the HA layer being amorphous while the rest
of the crystalline layer is hexagonally packed
Indicated Fresh extraction sites
Newly grafted sites
Advantages
1 Protection of surrounding bone against metal ion release from the
substrate
2 Reported chemical bonding between HA and living bone-intimate
contact-biointegration
3 Partial dissolution of HA makes surrounding fluid rich in calcium
and phosphate ions which trigger cellular differentiation and bone
formation
Disadvantages
Induction of impurities due to thermal decomposition during
processing- affecting long term clinical fixation
Dissolution of HA at lower pH
HA coating on the implant surface (50-70microm) by various methods
1 Plasma spraying
2 The vacuum deposition technique(ion beam sputtering radiofrequency
sputtering)
3 The sol gel and dip coating method
4 Electrolytic process
Nanotitania coatings
Nanotitania coatings were prepared by using the sol-gel
technique
Nanotitania implants had an increased feature density and a large
feature coverage area as compared to the nano-HA implants
This could present more binding sites for the protein cell
attachment and for increased bone contact
he Nanotitania implants exhibited an ordered arrangement
forming a homogenous layer on underlying topography
Biologically active drugs incorporated dental
implants
Bisphosphonates Bisphosphate-loaded implant surfaces have
been reported to improve implant osseointegration
Simvastatin
Simvastatin could induce the expression of bone morphogenetic
protein (BMP) mRNA that might promote bone formation and
increase bone mineral density
Gentamycin along with the layer of HA can be coated onto the
implant surface which may act as a local prophylactic agent along
with the systemic antibiotics in dental implant surgery
Biochemical Methods
of the Surface
Modifications
Biochemical Methods of the Surface
Modifications
Their goal is to immobilize proteins enzymes or peptides on
biomaterials for the purpose of inducing specific cell and tissue
responses
1 One approach uses cell-adhesion molecules like fibronectin
vitronectin Type I collagen osteogenin and bone sialoprotein
2 The second approach uses biomolecules with osteotropic
effects which range from mitogenicity (interleukin growth
factor-I FGF-2 platelet derived growth factor ndashBB) to the
increasing activity of the bone cells which enhances the
collagen synthesis for osteoinduction
Zirconia implants
Zirconia (Zr02) is a ceramic material used in implantology because
Biocompatibility(bio inert)
Esthetics (because its colour is similar to the teeth) and
Mechanical properties which are better than alumina
High resistance to corrosion flexion and fracture
Contact with bone and soft tissue similar to that observed in
titanium implants
It can be used to produce a entire implant or as a coating
Advantages of Zirconia Dental Implants
No dark colour of the metal showing through the gums
No corrosion of the zirconia as with titanium
No piezo-electric currents between dissimilar metal in
the mouth
It is thermally non-conductive
Greater BIC (Bone ndash Implant Contact)
20 more bone apposition than titanium implants
Zeynep Ouml zkurt Zirconia Dental Implants A Literature Review Journal of Oral Implantology Vol 37(3)2011
RTQ (removal torque testing) Gahlert et al evaluated the RTQ values of
machined zirconia implants sandblasted zirconia implants and SLA titanium
implants The mean RTQ for machined zirconia implants was 259 Ncm the
mean RTQ for zirconia rough implants was 405 Ncm and the mean RTQ for
SLA titanium implants was 1052 Ncm
Fracture strength within clinically acceptable limits
Stress analysis Kohal et al observed the stress distribution patterns of
zirconia implants (ReImplant) which were found to have low well distributed
and similar stress distribution compared with titanium implants
PEEK implants (poly etheretherketone)
These implants are available in three fundamentally different
designs
TAU Diameter -48 mm lengths 10 125 15 mm
immediate loading possible
Low density bone
THETA Similar to TAU but D1 bone
IOTA It is a 3mm diameter implant (10 and 12 mm)
used in narrow ridges
Advantages
Good strengthfracture resistance and bioinertness
Promotes human oseteoblast cell growth
Disadvantages
Faintly radiopaque ndashdifficult for post-op evaluation
Lengths and diameters range is restricted
Advances in
commercially
available implant
systems
LASER- LOK TECHNOLOGY
Unique surface characteristics
Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using
laser ablation technology
Extremely consistent microchannels that are optimally
sized to attach and organize both osteoblasts and
fibroblasts
Includes a repeating nanostructure that maximizes
surface area and enables cell pseudopodia and collagen
microfibrils to interdigitate with the Laser-Lok surface
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Advances in Implant materials
Previously implants had macro-irregularities like macroscopic
threads fenestrations pores grooves steps threads or other
surface irregularities that were visible
However difficulty in achieving initial stability post implantation
relative motion adverse interfacial bone remodelling all lead to
search for improvement of the surface quality of a titanium dental
implant
BLASTING
Blasting -aluminium oxide titanium oxide and calcium phosphate
with particle size ranging from small medium to large (150- 350
microm)
Blasting a smooth Ti surface with Al2 O3 particles of 25 microm 75 microm
or 250 microm produces surfaces with roughness values of 116 to 120
143 and 194 to 220 respectively
A series of investigations have demonstrated a firmer bone
fixation of the implant with an average surface roughness (sa) of 1-
15microm than those of smoother implants with an average surface
roughness of 06microm
Blasting and Acid Etching
Acid etching can be done by using an HCL H2 SO4 mixture or by
pickling in 2 HF10HNO3 These processes leave pits and craters
Alumina or TiO2 for blasting the surface
Small - 25μm
large grit -025-05mm
medium grit - 250-500μm
Sand blasted and acid etched surfaces have a hydrophobic surface
The etching leads to the formation of Titanium hydrides and the
replacement of hydride by oxygen results in the slow transformation of
the implant surface resulting in nanometre sized particles of titanium on
the surface which helps in protein adhesion on implant surface
Dual acid etching with HCl and H2SO4 heated above 100ᴼC has
produced surface topography able to attach to fibrin scaffold and
promote adhesion of osteogenic cells
Sand blasting and etching can increase the rate and amount of the
bone formation
Flouride Surface Treatments
This treatment enhances osseointegration and osteoblastic
differentitation with increased expression of Cbfa1 osterix and
bone sialoprotein
Fluoridated rough implants also withstood greater push-out
forces and showed a significantly higher removal torque than
control implants
However detrimental effect of F on the corrosion resistance of
titanium and titanium alloys has been extensively reported
Anodized Surface Implants
Anodized surface implants are implants which are placed as anodes
in galvanic cells with phosphoric acid as the electrolyte and current is
passed through them ndash also ca ldquoTiunite surfacerdquo
The surface oxides grow from the native state of 5nm to
approximately 10000nm
The sa of TiUnite is reported to be 11microm and its sdr 37
Anodic oxidation results in the growth of a native titanium oxide
layer and a porous topography with the bone formation occurring
directly on the moderately rough oxidized surface
Clinical and Radiographic Evaluation of Braringnemark Implants with an
Anodized Surface following Seven-to-Eight Years of Functional Loading
David Gelb Bradley McaAllister et al Int J Dent 2013 2013 583567
The aim of this study was to evaluate the clinical and
radiographic long-term outcomes of dental implants with an
anodized TiUnite surface placed in routine clinical practice
38 single prosthesis
22 FPDs
80 implants in maxilla
27 in mandible
Mean marginal bone level change-149 plusmn 103 mm
907 of cases- no visible plaque93 -visible plaque
No prosthetic complication
Calandriello evaluated immediately placed anodized
implants in 33 patients and found a mean marginal bone
loss of 117thinspmm after 5 years
Friberg and Jemt compared 280 TiUnite implants to 110
machined implants in 111 patients and found marginal
bone loss after 5 years to be 075 and 06thinspmm respectively
with no significant difference between the two types of
implants
Laser etching and Micro Arc Oxidation
After the implants are ultrasonically cleaned they are laser etched
by using an NdYAG laser at a power of 50kw frequency of 75khz
and 164A current
They are then processed in an electrolyte solution with 35
glyceroposphate disodium salt pentahydrate and 12 calcium
acetate monohydrate by microarc oxidation (voltage 350v
frequency 800hz) for 15 seconds
Microarc oxidation produces a titania film with a porous structure
and micropores of 1-5microm
The mechanism of osseointegration of the oxidized implants has
been shown to be mechanical interlocking and biochemical
bonding
Surface coating Ti Plasma Spray
Porous rough Ti surface have been fabricated by plasma
spraying a Ti powder form of molten droplets at high temperature
at temperature in order of 15000C at 600ms
The Ti plasma spray after solidification often provides 004 ndash 005
mm thickness
Ti A spray has been reported to increase the surface area of bone
to implant interface (as much as 600) and stimulate adhesion
osteogenesis
Advantages
Enhance attachment by increasing ionic interactions
Increased load bearing capability by 25-30
Increased tensile strength through ingrowth of bony tissues into 3D feature
Disadvantages
Cracking and scaling of coating because of stresses produced by elevated temprature processing
Risk of accumulation of abraded material in the interface zone during implantation of TPS
Hydroxyapatite coatings
Hydroxyapatite [Ca10(PO4)6OH]2 coating was brought to the
dental profession by DeGroot
HA forms a strong chemical bond with bone due to the presence
of free calcium and phosphate compounds at the implant surface
The HA coating consists of amorphous and crystalline forms with
a large density of cracks
The top 1-2 microm of the HA layer being amorphous while the rest
of the crystalline layer is hexagonally packed
Indicated Fresh extraction sites
Newly grafted sites
Advantages
1 Protection of surrounding bone against metal ion release from the
substrate
2 Reported chemical bonding between HA and living bone-intimate
contact-biointegration
3 Partial dissolution of HA makes surrounding fluid rich in calcium
and phosphate ions which trigger cellular differentiation and bone
formation
Disadvantages
Induction of impurities due to thermal decomposition during
processing- affecting long term clinical fixation
Dissolution of HA at lower pH
HA coating on the implant surface (50-70microm) by various methods
1 Plasma spraying
2 The vacuum deposition technique(ion beam sputtering radiofrequency
sputtering)
3 The sol gel and dip coating method
4 Electrolytic process
Nanotitania coatings
Nanotitania coatings were prepared by using the sol-gel
technique
Nanotitania implants had an increased feature density and a large
feature coverage area as compared to the nano-HA implants
This could present more binding sites for the protein cell
attachment and for increased bone contact
he Nanotitania implants exhibited an ordered arrangement
forming a homogenous layer on underlying topography
Biologically active drugs incorporated dental
implants
Bisphosphonates Bisphosphate-loaded implant surfaces have
been reported to improve implant osseointegration
Simvastatin
Simvastatin could induce the expression of bone morphogenetic
protein (BMP) mRNA that might promote bone formation and
increase bone mineral density
Gentamycin along with the layer of HA can be coated onto the
implant surface which may act as a local prophylactic agent along
with the systemic antibiotics in dental implant surgery
Biochemical Methods
of the Surface
Modifications
Biochemical Methods of the Surface
Modifications
Their goal is to immobilize proteins enzymes or peptides on
biomaterials for the purpose of inducing specific cell and tissue
responses
1 One approach uses cell-adhesion molecules like fibronectin
vitronectin Type I collagen osteogenin and bone sialoprotein
2 The second approach uses biomolecules with osteotropic
effects which range from mitogenicity (interleukin growth
factor-I FGF-2 platelet derived growth factor ndashBB) to the
increasing activity of the bone cells which enhances the
collagen synthesis for osteoinduction
Zirconia implants
Zirconia (Zr02) is a ceramic material used in implantology because
Biocompatibility(bio inert)
Esthetics (because its colour is similar to the teeth) and
Mechanical properties which are better than alumina
High resistance to corrosion flexion and fracture
Contact with bone and soft tissue similar to that observed in
titanium implants
It can be used to produce a entire implant or as a coating
Advantages of Zirconia Dental Implants
No dark colour of the metal showing through the gums
No corrosion of the zirconia as with titanium
No piezo-electric currents between dissimilar metal in
the mouth
It is thermally non-conductive
Greater BIC (Bone ndash Implant Contact)
20 more bone apposition than titanium implants
Zeynep Ouml zkurt Zirconia Dental Implants A Literature Review Journal of Oral Implantology Vol 37(3)2011
RTQ (removal torque testing) Gahlert et al evaluated the RTQ values of
machined zirconia implants sandblasted zirconia implants and SLA titanium
implants The mean RTQ for machined zirconia implants was 259 Ncm the
mean RTQ for zirconia rough implants was 405 Ncm and the mean RTQ for
SLA titanium implants was 1052 Ncm
Fracture strength within clinically acceptable limits
Stress analysis Kohal et al observed the stress distribution patterns of
zirconia implants (ReImplant) which were found to have low well distributed
and similar stress distribution compared with titanium implants
PEEK implants (poly etheretherketone)
These implants are available in three fundamentally different
designs
TAU Diameter -48 mm lengths 10 125 15 mm
immediate loading possible
Low density bone
THETA Similar to TAU but D1 bone
IOTA It is a 3mm diameter implant (10 and 12 mm)
used in narrow ridges
Advantages
Good strengthfracture resistance and bioinertness
Promotes human oseteoblast cell growth
Disadvantages
Faintly radiopaque ndashdifficult for post-op evaluation
Lengths and diameters range is restricted
Advances in
commercially
available implant
systems
LASER- LOK TECHNOLOGY
Unique surface characteristics
Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using
laser ablation technology
Extremely consistent microchannels that are optimally
sized to attach and organize both osteoblasts and
fibroblasts
Includes a repeating nanostructure that maximizes
surface area and enables cell pseudopodia and collagen
microfibrils to interdigitate with the Laser-Lok surface
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Previously implants had macro-irregularities like macroscopic
threads fenestrations pores grooves steps threads or other
surface irregularities that were visible
However difficulty in achieving initial stability post implantation
relative motion adverse interfacial bone remodelling all lead to
search for improvement of the surface quality of a titanium dental
implant
BLASTING
Blasting -aluminium oxide titanium oxide and calcium phosphate
with particle size ranging from small medium to large (150- 350
microm)
Blasting a smooth Ti surface with Al2 O3 particles of 25 microm 75 microm
or 250 microm produces surfaces with roughness values of 116 to 120
143 and 194 to 220 respectively
A series of investigations have demonstrated a firmer bone
fixation of the implant with an average surface roughness (sa) of 1-
15microm than those of smoother implants with an average surface
roughness of 06microm
Blasting and Acid Etching
Acid etching can be done by using an HCL H2 SO4 mixture or by
pickling in 2 HF10HNO3 These processes leave pits and craters
Alumina or TiO2 for blasting the surface
Small - 25μm
large grit -025-05mm
medium grit - 250-500μm
Sand blasted and acid etched surfaces have a hydrophobic surface
The etching leads to the formation of Titanium hydrides and the
replacement of hydride by oxygen results in the slow transformation of
the implant surface resulting in nanometre sized particles of titanium on
the surface which helps in protein adhesion on implant surface
Dual acid etching with HCl and H2SO4 heated above 100ᴼC has
produced surface topography able to attach to fibrin scaffold and
promote adhesion of osteogenic cells
Sand blasting and etching can increase the rate and amount of the
bone formation
Flouride Surface Treatments
This treatment enhances osseointegration and osteoblastic
differentitation with increased expression of Cbfa1 osterix and
bone sialoprotein
Fluoridated rough implants also withstood greater push-out
forces and showed a significantly higher removal torque than
control implants
However detrimental effect of F on the corrosion resistance of
titanium and titanium alloys has been extensively reported
Anodized Surface Implants
Anodized surface implants are implants which are placed as anodes
in galvanic cells with phosphoric acid as the electrolyte and current is
passed through them ndash also ca ldquoTiunite surfacerdquo
The surface oxides grow from the native state of 5nm to
approximately 10000nm
The sa of TiUnite is reported to be 11microm and its sdr 37
Anodic oxidation results in the growth of a native titanium oxide
layer and a porous topography with the bone formation occurring
directly on the moderately rough oxidized surface
Clinical and Radiographic Evaluation of Braringnemark Implants with an
Anodized Surface following Seven-to-Eight Years of Functional Loading
David Gelb Bradley McaAllister et al Int J Dent 2013 2013 583567
The aim of this study was to evaluate the clinical and
radiographic long-term outcomes of dental implants with an
anodized TiUnite surface placed in routine clinical practice
38 single prosthesis
22 FPDs
80 implants in maxilla
27 in mandible
Mean marginal bone level change-149 plusmn 103 mm
907 of cases- no visible plaque93 -visible plaque
No prosthetic complication
Calandriello evaluated immediately placed anodized
implants in 33 patients and found a mean marginal bone
loss of 117thinspmm after 5 years
Friberg and Jemt compared 280 TiUnite implants to 110
machined implants in 111 patients and found marginal
bone loss after 5 years to be 075 and 06thinspmm respectively
with no significant difference between the two types of
implants
Laser etching and Micro Arc Oxidation
After the implants are ultrasonically cleaned they are laser etched
by using an NdYAG laser at a power of 50kw frequency of 75khz
and 164A current
They are then processed in an electrolyte solution with 35
glyceroposphate disodium salt pentahydrate and 12 calcium
acetate monohydrate by microarc oxidation (voltage 350v
frequency 800hz) for 15 seconds
Microarc oxidation produces a titania film with a porous structure
and micropores of 1-5microm
The mechanism of osseointegration of the oxidized implants has
been shown to be mechanical interlocking and biochemical
bonding
Surface coating Ti Plasma Spray
Porous rough Ti surface have been fabricated by plasma
spraying a Ti powder form of molten droplets at high temperature
at temperature in order of 15000C at 600ms
The Ti plasma spray after solidification often provides 004 ndash 005
mm thickness
Ti A spray has been reported to increase the surface area of bone
to implant interface (as much as 600) and stimulate adhesion
osteogenesis
Advantages
Enhance attachment by increasing ionic interactions
Increased load bearing capability by 25-30
Increased tensile strength through ingrowth of bony tissues into 3D feature
Disadvantages
Cracking and scaling of coating because of stresses produced by elevated temprature processing
Risk of accumulation of abraded material in the interface zone during implantation of TPS
Hydroxyapatite coatings
Hydroxyapatite [Ca10(PO4)6OH]2 coating was brought to the
dental profession by DeGroot
HA forms a strong chemical bond with bone due to the presence
of free calcium and phosphate compounds at the implant surface
The HA coating consists of amorphous and crystalline forms with
a large density of cracks
The top 1-2 microm of the HA layer being amorphous while the rest
of the crystalline layer is hexagonally packed
Indicated Fresh extraction sites
Newly grafted sites
Advantages
1 Protection of surrounding bone against metal ion release from the
substrate
2 Reported chemical bonding between HA and living bone-intimate
contact-biointegration
3 Partial dissolution of HA makes surrounding fluid rich in calcium
and phosphate ions which trigger cellular differentiation and bone
formation
Disadvantages
Induction of impurities due to thermal decomposition during
processing- affecting long term clinical fixation
Dissolution of HA at lower pH
HA coating on the implant surface (50-70microm) by various methods
1 Plasma spraying
2 The vacuum deposition technique(ion beam sputtering radiofrequency
sputtering)
3 The sol gel and dip coating method
4 Electrolytic process
Nanotitania coatings
Nanotitania coatings were prepared by using the sol-gel
technique
Nanotitania implants had an increased feature density and a large
feature coverage area as compared to the nano-HA implants
This could present more binding sites for the protein cell
attachment and for increased bone contact
he Nanotitania implants exhibited an ordered arrangement
forming a homogenous layer on underlying topography
Biologically active drugs incorporated dental
implants
Bisphosphonates Bisphosphate-loaded implant surfaces have
been reported to improve implant osseointegration
Simvastatin
Simvastatin could induce the expression of bone morphogenetic
protein (BMP) mRNA that might promote bone formation and
increase bone mineral density
Gentamycin along with the layer of HA can be coated onto the
implant surface which may act as a local prophylactic agent along
with the systemic antibiotics in dental implant surgery
Biochemical Methods
of the Surface
Modifications
Biochemical Methods of the Surface
Modifications
Their goal is to immobilize proteins enzymes or peptides on
biomaterials for the purpose of inducing specific cell and tissue
responses
1 One approach uses cell-adhesion molecules like fibronectin
vitronectin Type I collagen osteogenin and bone sialoprotein
2 The second approach uses biomolecules with osteotropic
effects which range from mitogenicity (interleukin growth
factor-I FGF-2 platelet derived growth factor ndashBB) to the
increasing activity of the bone cells which enhances the
collagen synthesis for osteoinduction
Zirconia implants
Zirconia (Zr02) is a ceramic material used in implantology because
Biocompatibility(bio inert)
Esthetics (because its colour is similar to the teeth) and
Mechanical properties which are better than alumina
High resistance to corrosion flexion and fracture
Contact with bone and soft tissue similar to that observed in
titanium implants
It can be used to produce a entire implant or as a coating
Advantages of Zirconia Dental Implants
No dark colour of the metal showing through the gums
No corrosion of the zirconia as with titanium
No piezo-electric currents between dissimilar metal in
the mouth
It is thermally non-conductive
Greater BIC (Bone ndash Implant Contact)
20 more bone apposition than titanium implants
Zeynep Ouml zkurt Zirconia Dental Implants A Literature Review Journal of Oral Implantology Vol 37(3)2011
RTQ (removal torque testing) Gahlert et al evaluated the RTQ values of
machined zirconia implants sandblasted zirconia implants and SLA titanium
implants The mean RTQ for machined zirconia implants was 259 Ncm the
mean RTQ for zirconia rough implants was 405 Ncm and the mean RTQ for
SLA titanium implants was 1052 Ncm
Fracture strength within clinically acceptable limits
Stress analysis Kohal et al observed the stress distribution patterns of
zirconia implants (ReImplant) which were found to have low well distributed
and similar stress distribution compared with titanium implants
PEEK implants (poly etheretherketone)
These implants are available in three fundamentally different
designs
TAU Diameter -48 mm lengths 10 125 15 mm
immediate loading possible
Low density bone
THETA Similar to TAU but D1 bone
IOTA It is a 3mm diameter implant (10 and 12 mm)
used in narrow ridges
Advantages
Good strengthfracture resistance and bioinertness
Promotes human oseteoblast cell growth
Disadvantages
Faintly radiopaque ndashdifficult for post-op evaluation
Lengths and diameters range is restricted
Advances in
commercially
available implant
systems
LASER- LOK TECHNOLOGY
Unique surface characteristics
Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using
laser ablation technology
Extremely consistent microchannels that are optimally
sized to attach and organize both osteoblasts and
fibroblasts
Includes a repeating nanostructure that maximizes
surface area and enables cell pseudopodia and collagen
microfibrils to interdigitate with the Laser-Lok surface
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
BLASTING
Blasting -aluminium oxide titanium oxide and calcium phosphate
with particle size ranging from small medium to large (150- 350
microm)
Blasting a smooth Ti surface with Al2 O3 particles of 25 microm 75 microm
or 250 microm produces surfaces with roughness values of 116 to 120
143 and 194 to 220 respectively
A series of investigations have demonstrated a firmer bone
fixation of the implant with an average surface roughness (sa) of 1-
15microm than those of smoother implants with an average surface
roughness of 06microm
Blasting and Acid Etching
Acid etching can be done by using an HCL H2 SO4 mixture or by
pickling in 2 HF10HNO3 These processes leave pits and craters
Alumina or TiO2 for blasting the surface
Small - 25μm
large grit -025-05mm
medium grit - 250-500μm
Sand blasted and acid etched surfaces have a hydrophobic surface
The etching leads to the formation of Titanium hydrides and the
replacement of hydride by oxygen results in the slow transformation of
the implant surface resulting in nanometre sized particles of titanium on
the surface which helps in protein adhesion on implant surface
Dual acid etching with HCl and H2SO4 heated above 100ᴼC has
produced surface topography able to attach to fibrin scaffold and
promote adhesion of osteogenic cells
Sand blasting and etching can increase the rate and amount of the
bone formation
Flouride Surface Treatments
This treatment enhances osseointegration and osteoblastic
differentitation with increased expression of Cbfa1 osterix and
bone sialoprotein
Fluoridated rough implants also withstood greater push-out
forces and showed a significantly higher removal torque than
control implants
However detrimental effect of F on the corrosion resistance of
titanium and titanium alloys has been extensively reported
Anodized Surface Implants
Anodized surface implants are implants which are placed as anodes
in galvanic cells with phosphoric acid as the electrolyte and current is
passed through them ndash also ca ldquoTiunite surfacerdquo
The surface oxides grow from the native state of 5nm to
approximately 10000nm
The sa of TiUnite is reported to be 11microm and its sdr 37
Anodic oxidation results in the growth of a native titanium oxide
layer and a porous topography with the bone formation occurring
directly on the moderately rough oxidized surface
Clinical and Radiographic Evaluation of Braringnemark Implants with an
Anodized Surface following Seven-to-Eight Years of Functional Loading
David Gelb Bradley McaAllister et al Int J Dent 2013 2013 583567
The aim of this study was to evaluate the clinical and
radiographic long-term outcomes of dental implants with an
anodized TiUnite surface placed in routine clinical practice
38 single prosthesis
22 FPDs
80 implants in maxilla
27 in mandible
Mean marginal bone level change-149 plusmn 103 mm
907 of cases- no visible plaque93 -visible plaque
No prosthetic complication
Calandriello evaluated immediately placed anodized
implants in 33 patients and found a mean marginal bone
loss of 117thinspmm after 5 years
Friberg and Jemt compared 280 TiUnite implants to 110
machined implants in 111 patients and found marginal
bone loss after 5 years to be 075 and 06thinspmm respectively
with no significant difference between the two types of
implants
Laser etching and Micro Arc Oxidation
After the implants are ultrasonically cleaned they are laser etched
by using an NdYAG laser at a power of 50kw frequency of 75khz
and 164A current
They are then processed in an electrolyte solution with 35
glyceroposphate disodium salt pentahydrate and 12 calcium
acetate monohydrate by microarc oxidation (voltage 350v
frequency 800hz) for 15 seconds
Microarc oxidation produces a titania film with a porous structure
and micropores of 1-5microm
The mechanism of osseointegration of the oxidized implants has
been shown to be mechanical interlocking and biochemical
bonding
Surface coating Ti Plasma Spray
Porous rough Ti surface have been fabricated by plasma
spraying a Ti powder form of molten droplets at high temperature
at temperature in order of 15000C at 600ms
The Ti plasma spray after solidification often provides 004 ndash 005
mm thickness
Ti A spray has been reported to increase the surface area of bone
to implant interface (as much as 600) and stimulate adhesion
osteogenesis
Advantages
Enhance attachment by increasing ionic interactions
Increased load bearing capability by 25-30
Increased tensile strength through ingrowth of bony tissues into 3D feature
Disadvantages
Cracking and scaling of coating because of stresses produced by elevated temprature processing
Risk of accumulation of abraded material in the interface zone during implantation of TPS
Hydroxyapatite coatings
Hydroxyapatite [Ca10(PO4)6OH]2 coating was brought to the
dental profession by DeGroot
HA forms a strong chemical bond with bone due to the presence
of free calcium and phosphate compounds at the implant surface
The HA coating consists of amorphous and crystalline forms with
a large density of cracks
The top 1-2 microm of the HA layer being amorphous while the rest
of the crystalline layer is hexagonally packed
Indicated Fresh extraction sites
Newly grafted sites
Advantages
1 Protection of surrounding bone against metal ion release from the
substrate
2 Reported chemical bonding between HA and living bone-intimate
contact-biointegration
3 Partial dissolution of HA makes surrounding fluid rich in calcium
and phosphate ions which trigger cellular differentiation and bone
formation
Disadvantages
Induction of impurities due to thermal decomposition during
processing- affecting long term clinical fixation
Dissolution of HA at lower pH
HA coating on the implant surface (50-70microm) by various methods
1 Plasma spraying
2 The vacuum deposition technique(ion beam sputtering radiofrequency
sputtering)
3 The sol gel and dip coating method
4 Electrolytic process
Nanotitania coatings
Nanotitania coatings were prepared by using the sol-gel
technique
Nanotitania implants had an increased feature density and a large
feature coverage area as compared to the nano-HA implants
This could present more binding sites for the protein cell
attachment and for increased bone contact
he Nanotitania implants exhibited an ordered arrangement
forming a homogenous layer on underlying topography
Biologically active drugs incorporated dental
implants
Bisphosphonates Bisphosphate-loaded implant surfaces have
been reported to improve implant osseointegration
Simvastatin
Simvastatin could induce the expression of bone morphogenetic
protein (BMP) mRNA that might promote bone formation and
increase bone mineral density
Gentamycin along with the layer of HA can be coated onto the
implant surface which may act as a local prophylactic agent along
with the systemic antibiotics in dental implant surgery
Biochemical Methods
of the Surface
Modifications
Biochemical Methods of the Surface
Modifications
Their goal is to immobilize proteins enzymes or peptides on
biomaterials for the purpose of inducing specific cell and tissue
responses
1 One approach uses cell-adhesion molecules like fibronectin
vitronectin Type I collagen osteogenin and bone sialoprotein
2 The second approach uses biomolecules with osteotropic
effects which range from mitogenicity (interleukin growth
factor-I FGF-2 platelet derived growth factor ndashBB) to the
increasing activity of the bone cells which enhances the
collagen synthesis for osteoinduction
Zirconia implants
Zirconia (Zr02) is a ceramic material used in implantology because
Biocompatibility(bio inert)
Esthetics (because its colour is similar to the teeth) and
Mechanical properties which are better than alumina
High resistance to corrosion flexion and fracture
Contact with bone and soft tissue similar to that observed in
titanium implants
It can be used to produce a entire implant or as a coating
Advantages of Zirconia Dental Implants
No dark colour of the metal showing through the gums
No corrosion of the zirconia as with titanium
No piezo-electric currents between dissimilar metal in
the mouth
It is thermally non-conductive
Greater BIC (Bone ndash Implant Contact)
20 more bone apposition than titanium implants
Zeynep Ouml zkurt Zirconia Dental Implants A Literature Review Journal of Oral Implantology Vol 37(3)2011
RTQ (removal torque testing) Gahlert et al evaluated the RTQ values of
machined zirconia implants sandblasted zirconia implants and SLA titanium
implants The mean RTQ for machined zirconia implants was 259 Ncm the
mean RTQ for zirconia rough implants was 405 Ncm and the mean RTQ for
SLA titanium implants was 1052 Ncm
Fracture strength within clinically acceptable limits
Stress analysis Kohal et al observed the stress distribution patterns of
zirconia implants (ReImplant) which were found to have low well distributed
and similar stress distribution compared with titanium implants
PEEK implants (poly etheretherketone)
These implants are available in three fundamentally different
designs
TAU Diameter -48 mm lengths 10 125 15 mm
immediate loading possible
Low density bone
THETA Similar to TAU but D1 bone
IOTA It is a 3mm diameter implant (10 and 12 mm)
used in narrow ridges
Advantages
Good strengthfracture resistance and bioinertness
Promotes human oseteoblast cell growth
Disadvantages
Faintly radiopaque ndashdifficult for post-op evaluation
Lengths and diameters range is restricted
Advances in
commercially
available implant
systems
LASER- LOK TECHNOLOGY
Unique surface characteristics
Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using
laser ablation technology
Extremely consistent microchannels that are optimally
sized to attach and organize both osteoblasts and
fibroblasts
Includes a repeating nanostructure that maximizes
surface area and enables cell pseudopodia and collagen
microfibrils to interdigitate with the Laser-Lok surface
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Blasting and Acid Etching
Acid etching can be done by using an HCL H2 SO4 mixture or by
pickling in 2 HF10HNO3 These processes leave pits and craters
Alumina or TiO2 for blasting the surface
Small - 25μm
large grit -025-05mm
medium grit - 250-500μm
Sand blasted and acid etched surfaces have a hydrophobic surface
The etching leads to the formation of Titanium hydrides and the
replacement of hydride by oxygen results in the slow transformation of
the implant surface resulting in nanometre sized particles of titanium on
the surface which helps in protein adhesion on implant surface
Dual acid etching with HCl and H2SO4 heated above 100ᴼC has
produced surface topography able to attach to fibrin scaffold and
promote adhesion of osteogenic cells
Sand blasting and etching can increase the rate and amount of the
bone formation
Flouride Surface Treatments
This treatment enhances osseointegration and osteoblastic
differentitation with increased expression of Cbfa1 osterix and
bone sialoprotein
Fluoridated rough implants also withstood greater push-out
forces and showed a significantly higher removal torque than
control implants
However detrimental effect of F on the corrosion resistance of
titanium and titanium alloys has been extensively reported
Anodized Surface Implants
Anodized surface implants are implants which are placed as anodes
in galvanic cells with phosphoric acid as the electrolyte and current is
passed through them ndash also ca ldquoTiunite surfacerdquo
The surface oxides grow from the native state of 5nm to
approximately 10000nm
The sa of TiUnite is reported to be 11microm and its sdr 37
Anodic oxidation results in the growth of a native titanium oxide
layer and a porous topography with the bone formation occurring
directly on the moderately rough oxidized surface
Clinical and Radiographic Evaluation of Braringnemark Implants with an
Anodized Surface following Seven-to-Eight Years of Functional Loading
David Gelb Bradley McaAllister et al Int J Dent 2013 2013 583567
The aim of this study was to evaluate the clinical and
radiographic long-term outcomes of dental implants with an
anodized TiUnite surface placed in routine clinical practice
38 single prosthesis
22 FPDs
80 implants in maxilla
27 in mandible
Mean marginal bone level change-149 plusmn 103 mm
907 of cases- no visible plaque93 -visible plaque
No prosthetic complication
Calandriello evaluated immediately placed anodized
implants in 33 patients and found a mean marginal bone
loss of 117thinspmm after 5 years
Friberg and Jemt compared 280 TiUnite implants to 110
machined implants in 111 patients and found marginal
bone loss after 5 years to be 075 and 06thinspmm respectively
with no significant difference between the two types of
implants
Laser etching and Micro Arc Oxidation
After the implants are ultrasonically cleaned they are laser etched
by using an NdYAG laser at a power of 50kw frequency of 75khz
and 164A current
They are then processed in an electrolyte solution with 35
glyceroposphate disodium salt pentahydrate and 12 calcium
acetate monohydrate by microarc oxidation (voltage 350v
frequency 800hz) for 15 seconds
Microarc oxidation produces a titania film with a porous structure
and micropores of 1-5microm
The mechanism of osseointegration of the oxidized implants has
been shown to be mechanical interlocking and biochemical
bonding
Surface coating Ti Plasma Spray
Porous rough Ti surface have been fabricated by plasma
spraying a Ti powder form of molten droplets at high temperature
at temperature in order of 15000C at 600ms
The Ti plasma spray after solidification often provides 004 ndash 005
mm thickness
Ti A spray has been reported to increase the surface area of bone
to implant interface (as much as 600) and stimulate adhesion
osteogenesis
Advantages
Enhance attachment by increasing ionic interactions
Increased load bearing capability by 25-30
Increased tensile strength through ingrowth of bony tissues into 3D feature
Disadvantages
Cracking and scaling of coating because of stresses produced by elevated temprature processing
Risk of accumulation of abraded material in the interface zone during implantation of TPS
Hydroxyapatite coatings
Hydroxyapatite [Ca10(PO4)6OH]2 coating was brought to the
dental profession by DeGroot
HA forms a strong chemical bond with bone due to the presence
of free calcium and phosphate compounds at the implant surface
The HA coating consists of amorphous and crystalline forms with
a large density of cracks
The top 1-2 microm of the HA layer being amorphous while the rest
of the crystalline layer is hexagonally packed
Indicated Fresh extraction sites
Newly grafted sites
Advantages
1 Protection of surrounding bone against metal ion release from the
substrate
2 Reported chemical bonding between HA and living bone-intimate
contact-biointegration
3 Partial dissolution of HA makes surrounding fluid rich in calcium
and phosphate ions which trigger cellular differentiation and bone
formation
Disadvantages
Induction of impurities due to thermal decomposition during
processing- affecting long term clinical fixation
Dissolution of HA at lower pH
HA coating on the implant surface (50-70microm) by various methods
1 Plasma spraying
2 The vacuum deposition technique(ion beam sputtering radiofrequency
sputtering)
3 The sol gel and dip coating method
4 Electrolytic process
Nanotitania coatings
Nanotitania coatings were prepared by using the sol-gel
technique
Nanotitania implants had an increased feature density and a large
feature coverage area as compared to the nano-HA implants
This could present more binding sites for the protein cell
attachment and for increased bone contact
he Nanotitania implants exhibited an ordered arrangement
forming a homogenous layer on underlying topography
Biologically active drugs incorporated dental
implants
Bisphosphonates Bisphosphate-loaded implant surfaces have
been reported to improve implant osseointegration
Simvastatin
Simvastatin could induce the expression of bone morphogenetic
protein (BMP) mRNA that might promote bone formation and
increase bone mineral density
Gentamycin along with the layer of HA can be coated onto the
implant surface which may act as a local prophylactic agent along
with the systemic antibiotics in dental implant surgery
Biochemical Methods
of the Surface
Modifications
Biochemical Methods of the Surface
Modifications
Their goal is to immobilize proteins enzymes or peptides on
biomaterials for the purpose of inducing specific cell and tissue
responses
1 One approach uses cell-adhesion molecules like fibronectin
vitronectin Type I collagen osteogenin and bone sialoprotein
2 The second approach uses biomolecules with osteotropic
effects which range from mitogenicity (interleukin growth
factor-I FGF-2 platelet derived growth factor ndashBB) to the
increasing activity of the bone cells which enhances the
collagen synthesis for osteoinduction
Zirconia implants
Zirconia (Zr02) is a ceramic material used in implantology because
Biocompatibility(bio inert)
Esthetics (because its colour is similar to the teeth) and
Mechanical properties which are better than alumina
High resistance to corrosion flexion and fracture
Contact with bone and soft tissue similar to that observed in
titanium implants
It can be used to produce a entire implant or as a coating
Advantages of Zirconia Dental Implants
No dark colour of the metal showing through the gums
No corrosion of the zirconia as with titanium
No piezo-electric currents between dissimilar metal in
the mouth
It is thermally non-conductive
Greater BIC (Bone ndash Implant Contact)
20 more bone apposition than titanium implants
Zeynep Ouml zkurt Zirconia Dental Implants A Literature Review Journal of Oral Implantology Vol 37(3)2011
RTQ (removal torque testing) Gahlert et al evaluated the RTQ values of
machined zirconia implants sandblasted zirconia implants and SLA titanium
implants The mean RTQ for machined zirconia implants was 259 Ncm the
mean RTQ for zirconia rough implants was 405 Ncm and the mean RTQ for
SLA titanium implants was 1052 Ncm
Fracture strength within clinically acceptable limits
Stress analysis Kohal et al observed the stress distribution patterns of
zirconia implants (ReImplant) which were found to have low well distributed
and similar stress distribution compared with titanium implants
PEEK implants (poly etheretherketone)
These implants are available in three fundamentally different
designs
TAU Diameter -48 mm lengths 10 125 15 mm
immediate loading possible
Low density bone
THETA Similar to TAU but D1 bone
IOTA It is a 3mm diameter implant (10 and 12 mm)
used in narrow ridges
Advantages
Good strengthfracture resistance and bioinertness
Promotes human oseteoblast cell growth
Disadvantages
Faintly radiopaque ndashdifficult for post-op evaluation
Lengths and diameters range is restricted
Advances in
commercially
available implant
systems
LASER- LOK TECHNOLOGY
Unique surface characteristics
Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using
laser ablation technology
Extremely consistent microchannels that are optimally
sized to attach and organize both osteoblasts and
fibroblasts
Includes a repeating nanostructure that maximizes
surface area and enables cell pseudopodia and collagen
microfibrils to interdigitate with the Laser-Lok surface
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
The etching leads to the formation of Titanium hydrides and the
replacement of hydride by oxygen results in the slow transformation of
the implant surface resulting in nanometre sized particles of titanium on
the surface which helps in protein adhesion on implant surface
Dual acid etching with HCl and H2SO4 heated above 100ᴼC has
produced surface topography able to attach to fibrin scaffold and
promote adhesion of osteogenic cells
Sand blasting and etching can increase the rate and amount of the
bone formation
Flouride Surface Treatments
This treatment enhances osseointegration and osteoblastic
differentitation with increased expression of Cbfa1 osterix and
bone sialoprotein
Fluoridated rough implants also withstood greater push-out
forces and showed a significantly higher removal torque than
control implants
However detrimental effect of F on the corrosion resistance of
titanium and titanium alloys has been extensively reported
Anodized Surface Implants
Anodized surface implants are implants which are placed as anodes
in galvanic cells with phosphoric acid as the electrolyte and current is
passed through them ndash also ca ldquoTiunite surfacerdquo
The surface oxides grow from the native state of 5nm to
approximately 10000nm
The sa of TiUnite is reported to be 11microm and its sdr 37
Anodic oxidation results in the growth of a native titanium oxide
layer and a porous topography with the bone formation occurring
directly on the moderately rough oxidized surface
Clinical and Radiographic Evaluation of Braringnemark Implants with an
Anodized Surface following Seven-to-Eight Years of Functional Loading
David Gelb Bradley McaAllister et al Int J Dent 2013 2013 583567
The aim of this study was to evaluate the clinical and
radiographic long-term outcomes of dental implants with an
anodized TiUnite surface placed in routine clinical practice
38 single prosthesis
22 FPDs
80 implants in maxilla
27 in mandible
Mean marginal bone level change-149 plusmn 103 mm
907 of cases- no visible plaque93 -visible plaque
No prosthetic complication
Calandriello evaluated immediately placed anodized
implants in 33 patients and found a mean marginal bone
loss of 117thinspmm after 5 years
Friberg and Jemt compared 280 TiUnite implants to 110
machined implants in 111 patients and found marginal
bone loss after 5 years to be 075 and 06thinspmm respectively
with no significant difference between the two types of
implants
Laser etching and Micro Arc Oxidation
After the implants are ultrasonically cleaned they are laser etched
by using an NdYAG laser at a power of 50kw frequency of 75khz
and 164A current
They are then processed in an electrolyte solution with 35
glyceroposphate disodium salt pentahydrate and 12 calcium
acetate monohydrate by microarc oxidation (voltage 350v
frequency 800hz) for 15 seconds
Microarc oxidation produces a titania film with a porous structure
and micropores of 1-5microm
The mechanism of osseointegration of the oxidized implants has
been shown to be mechanical interlocking and biochemical
bonding
Surface coating Ti Plasma Spray
Porous rough Ti surface have been fabricated by plasma
spraying a Ti powder form of molten droplets at high temperature
at temperature in order of 15000C at 600ms
The Ti plasma spray after solidification often provides 004 ndash 005
mm thickness
Ti A spray has been reported to increase the surface area of bone
to implant interface (as much as 600) and stimulate adhesion
osteogenesis
Advantages
Enhance attachment by increasing ionic interactions
Increased load bearing capability by 25-30
Increased tensile strength through ingrowth of bony tissues into 3D feature
Disadvantages
Cracking and scaling of coating because of stresses produced by elevated temprature processing
Risk of accumulation of abraded material in the interface zone during implantation of TPS
Hydroxyapatite coatings
Hydroxyapatite [Ca10(PO4)6OH]2 coating was brought to the
dental profession by DeGroot
HA forms a strong chemical bond with bone due to the presence
of free calcium and phosphate compounds at the implant surface
The HA coating consists of amorphous and crystalline forms with
a large density of cracks
The top 1-2 microm of the HA layer being amorphous while the rest
of the crystalline layer is hexagonally packed
Indicated Fresh extraction sites
Newly grafted sites
Advantages
1 Protection of surrounding bone against metal ion release from the
substrate
2 Reported chemical bonding between HA and living bone-intimate
contact-biointegration
3 Partial dissolution of HA makes surrounding fluid rich in calcium
and phosphate ions which trigger cellular differentiation and bone
formation
Disadvantages
Induction of impurities due to thermal decomposition during
processing- affecting long term clinical fixation
Dissolution of HA at lower pH
HA coating on the implant surface (50-70microm) by various methods
1 Plasma spraying
2 The vacuum deposition technique(ion beam sputtering radiofrequency
sputtering)
3 The sol gel and dip coating method
4 Electrolytic process
Nanotitania coatings
Nanotitania coatings were prepared by using the sol-gel
technique
Nanotitania implants had an increased feature density and a large
feature coverage area as compared to the nano-HA implants
This could present more binding sites for the protein cell
attachment and for increased bone contact
he Nanotitania implants exhibited an ordered arrangement
forming a homogenous layer on underlying topography
Biologically active drugs incorporated dental
implants
Bisphosphonates Bisphosphate-loaded implant surfaces have
been reported to improve implant osseointegration
Simvastatin
Simvastatin could induce the expression of bone morphogenetic
protein (BMP) mRNA that might promote bone formation and
increase bone mineral density
Gentamycin along with the layer of HA can be coated onto the
implant surface which may act as a local prophylactic agent along
with the systemic antibiotics in dental implant surgery
Biochemical Methods
of the Surface
Modifications
Biochemical Methods of the Surface
Modifications
Their goal is to immobilize proteins enzymes or peptides on
biomaterials for the purpose of inducing specific cell and tissue
responses
1 One approach uses cell-adhesion molecules like fibronectin
vitronectin Type I collagen osteogenin and bone sialoprotein
2 The second approach uses biomolecules with osteotropic
effects which range from mitogenicity (interleukin growth
factor-I FGF-2 platelet derived growth factor ndashBB) to the
increasing activity of the bone cells which enhances the
collagen synthesis for osteoinduction
Zirconia implants
Zirconia (Zr02) is a ceramic material used in implantology because
Biocompatibility(bio inert)
Esthetics (because its colour is similar to the teeth) and
Mechanical properties which are better than alumina
High resistance to corrosion flexion and fracture
Contact with bone and soft tissue similar to that observed in
titanium implants
It can be used to produce a entire implant or as a coating
Advantages of Zirconia Dental Implants
No dark colour of the metal showing through the gums
No corrosion of the zirconia as with titanium
No piezo-electric currents between dissimilar metal in
the mouth
It is thermally non-conductive
Greater BIC (Bone ndash Implant Contact)
20 more bone apposition than titanium implants
Zeynep Ouml zkurt Zirconia Dental Implants A Literature Review Journal of Oral Implantology Vol 37(3)2011
RTQ (removal torque testing) Gahlert et al evaluated the RTQ values of
machined zirconia implants sandblasted zirconia implants and SLA titanium
implants The mean RTQ for machined zirconia implants was 259 Ncm the
mean RTQ for zirconia rough implants was 405 Ncm and the mean RTQ for
SLA titanium implants was 1052 Ncm
Fracture strength within clinically acceptable limits
Stress analysis Kohal et al observed the stress distribution patterns of
zirconia implants (ReImplant) which were found to have low well distributed
and similar stress distribution compared with titanium implants
PEEK implants (poly etheretherketone)
These implants are available in three fundamentally different
designs
TAU Diameter -48 mm lengths 10 125 15 mm
immediate loading possible
Low density bone
THETA Similar to TAU but D1 bone
IOTA It is a 3mm diameter implant (10 and 12 mm)
used in narrow ridges
Advantages
Good strengthfracture resistance and bioinertness
Promotes human oseteoblast cell growth
Disadvantages
Faintly radiopaque ndashdifficult for post-op evaluation
Lengths and diameters range is restricted
Advances in
commercially
available implant
systems
LASER- LOK TECHNOLOGY
Unique surface characteristics
Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using
laser ablation technology
Extremely consistent microchannels that are optimally
sized to attach and organize both osteoblasts and
fibroblasts
Includes a repeating nanostructure that maximizes
surface area and enables cell pseudopodia and collagen
microfibrils to interdigitate with the Laser-Lok surface
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Flouride Surface Treatments
This treatment enhances osseointegration and osteoblastic
differentitation with increased expression of Cbfa1 osterix and
bone sialoprotein
Fluoridated rough implants also withstood greater push-out
forces and showed a significantly higher removal torque than
control implants
However detrimental effect of F on the corrosion resistance of
titanium and titanium alloys has been extensively reported
Anodized Surface Implants
Anodized surface implants are implants which are placed as anodes
in galvanic cells with phosphoric acid as the electrolyte and current is
passed through them ndash also ca ldquoTiunite surfacerdquo
The surface oxides grow from the native state of 5nm to
approximately 10000nm
The sa of TiUnite is reported to be 11microm and its sdr 37
Anodic oxidation results in the growth of a native titanium oxide
layer and a porous topography with the bone formation occurring
directly on the moderately rough oxidized surface
Clinical and Radiographic Evaluation of Braringnemark Implants with an
Anodized Surface following Seven-to-Eight Years of Functional Loading
David Gelb Bradley McaAllister et al Int J Dent 2013 2013 583567
The aim of this study was to evaluate the clinical and
radiographic long-term outcomes of dental implants with an
anodized TiUnite surface placed in routine clinical practice
38 single prosthesis
22 FPDs
80 implants in maxilla
27 in mandible
Mean marginal bone level change-149 plusmn 103 mm
907 of cases- no visible plaque93 -visible plaque
No prosthetic complication
Calandriello evaluated immediately placed anodized
implants in 33 patients and found a mean marginal bone
loss of 117thinspmm after 5 years
Friberg and Jemt compared 280 TiUnite implants to 110
machined implants in 111 patients and found marginal
bone loss after 5 years to be 075 and 06thinspmm respectively
with no significant difference between the two types of
implants
Laser etching and Micro Arc Oxidation
After the implants are ultrasonically cleaned they are laser etched
by using an NdYAG laser at a power of 50kw frequency of 75khz
and 164A current
They are then processed in an electrolyte solution with 35
glyceroposphate disodium salt pentahydrate and 12 calcium
acetate monohydrate by microarc oxidation (voltage 350v
frequency 800hz) for 15 seconds
Microarc oxidation produces a titania film with a porous structure
and micropores of 1-5microm
The mechanism of osseointegration of the oxidized implants has
been shown to be mechanical interlocking and biochemical
bonding
Surface coating Ti Plasma Spray
Porous rough Ti surface have been fabricated by plasma
spraying a Ti powder form of molten droplets at high temperature
at temperature in order of 15000C at 600ms
The Ti plasma spray after solidification often provides 004 ndash 005
mm thickness
Ti A spray has been reported to increase the surface area of bone
to implant interface (as much as 600) and stimulate adhesion
osteogenesis
Advantages
Enhance attachment by increasing ionic interactions
Increased load bearing capability by 25-30
Increased tensile strength through ingrowth of bony tissues into 3D feature
Disadvantages
Cracking and scaling of coating because of stresses produced by elevated temprature processing
Risk of accumulation of abraded material in the interface zone during implantation of TPS
Hydroxyapatite coatings
Hydroxyapatite [Ca10(PO4)6OH]2 coating was brought to the
dental profession by DeGroot
HA forms a strong chemical bond with bone due to the presence
of free calcium and phosphate compounds at the implant surface
The HA coating consists of amorphous and crystalline forms with
a large density of cracks
The top 1-2 microm of the HA layer being amorphous while the rest
of the crystalline layer is hexagonally packed
Indicated Fresh extraction sites
Newly grafted sites
Advantages
1 Protection of surrounding bone against metal ion release from the
substrate
2 Reported chemical bonding between HA and living bone-intimate
contact-biointegration
3 Partial dissolution of HA makes surrounding fluid rich in calcium
and phosphate ions which trigger cellular differentiation and bone
formation
Disadvantages
Induction of impurities due to thermal decomposition during
processing- affecting long term clinical fixation
Dissolution of HA at lower pH
HA coating on the implant surface (50-70microm) by various methods
1 Plasma spraying
2 The vacuum deposition technique(ion beam sputtering radiofrequency
sputtering)
3 The sol gel and dip coating method
4 Electrolytic process
Nanotitania coatings
Nanotitania coatings were prepared by using the sol-gel
technique
Nanotitania implants had an increased feature density and a large
feature coverage area as compared to the nano-HA implants
This could present more binding sites for the protein cell
attachment and for increased bone contact
he Nanotitania implants exhibited an ordered arrangement
forming a homogenous layer on underlying topography
Biologically active drugs incorporated dental
implants
Bisphosphonates Bisphosphate-loaded implant surfaces have
been reported to improve implant osseointegration
Simvastatin
Simvastatin could induce the expression of bone morphogenetic
protein (BMP) mRNA that might promote bone formation and
increase bone mineral density
Gentamycin along with the layer of HA can be coated onto the
implant surface which may act as a local prophylactic agent along
with the systemic antibiotics in dental implant surgery
Biochemical Methods
of the Surface
Modifications
Biochemical Methods of the Surface
Modifications
Their goal is to immobilize proteins enzymes or peptides on
biomaterials for the purpose of inducing specific cell and tissue
responses
1 One approach uses cell-adhesion molecules like fibronectin
vitronectin Type I collagen osteogenin and bone sialoprotein
2 The second approach uses biomolecules with osteotropic
effects which range from mitogenicity (interleukin growth
factor-I FGF-2 platelet derived growth factor ndashBB) to the
increasing activity of the bone cells which enhances the
collagen synthesis for osteoinduction
Zirconia implants
Zirconia (Zr02) is a ceramic material used in implantology because
Biocompatibility(bio inert)
Esthetics (because its colour is similar to the teeth) and
Mechanical properties which are better than alumina
High resistance to corrosion flexion and fracture
Contact with bone and soft tissue similar to that observed in
titanium implants
It can be used to produce a entire implant or as a coating
Advantages of Zirconia Dental Implants
No dark colour of the metal showing through the gums
No corrosion of the zirconia as with titanium
No piezo-electric currents between dissimilar metal in
the mouth
It is thermally non-conductive
Greater BIC (Bone ndash Implant Contact)
20 more bone apposition than titanium implants
Zeynep Ouml zkurt Zirconia Dental Implants A Literature Review Journal of Oral Implantology Vol 37(3)2011
RTQ (removal torque testing) Gahlert et al evaluated the RTQ values of
machined zirconia implants sandblasted zirconia implants and SLA titanium
implants The mean RTQ for machined zirconia implants was 259 Ncm the
mean RTQ for zirconia rough implants was 405 Ncm and the mean RTQ for
SLA titanium implants was 1052 Ncm
Fracture strength within clinically acceptable limits
Stress analysis Kohal et al observed the stress distribution patterns of
zirconia implants (ReImplant) which were found to have low well distributed
and similar stress distribution compared with titanium implants
PEEK implants (poly etheretherketone)
These implants are available in three fundamentally different
designs
TAU Diameter -48 mm lengths 10 125 15 mm
immediate loading possible
Low density bone
THETA Similar to TAU but D1 bone
IOTA It is a 3mm diameter implant (10 and 12 mm)
used in narrow ridges
Advantages
Good strengthfracture resistance and bioinertness
Promotes human oseteoblast cell growth
Disadvantages
Faintly radiopaque ndashdifficult for post-op evaluation
Lengths and diameters range is restricted
Advances in
commercially
available implant
systems
LASER- LOK TECHNOLOGY
Unique surface characteristics
Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using
laser ablation technology
Extremely consistent microchannels that are optimally
sized to attach and organize both osteoblasts and
fibroblasts
Includes a repeating nanostructure that maximizes
surface area and enables cell pseudopodia and collagen
microfibrils to interdigitate with the Laser-Lok surface
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Anodized Surface Implants
Anodized surface implants are implants which are placed as anodes
in galvanic cells with phosphoric acid as the electrolyte and current is
passed through them ndash also ca ldquoTiunite surfacerdquo
The surface oxides grow from the native state of 5nm to
approximately 10000nm
The sa of TiUnite is reported to be 11microm and its sdr 37
Anodic oxidation results in the growth of a native titanium oxide
layer and a porous topography with the bone formation occurring
directly on the moderately rough oxidized surface
Clinical and Radiographic Evaluation of Braringnemark Implants with an
Anodized Surface following Seven-to-Eight Years of Functional Loading
David Gelb Bradley McaAllister et al Int J Dent 2013 2013 583567
The aim of this study was to evaluate the clinical and
radiographic long-term outcomes of dental implants with an
anodized TiUnite surface placed in routine clinical practice
38 single prosthesis
22 FPDs
80 implants in maxilla
27 in mandible
Mean marginal bone level change-149 plusmn 103 mm
907 of cases- no visible plaque93 -visible plaque
No prosthetic complication
Calandriello evaluated immediately placed anodized
implants in 33 patients and found a mean marginal bone
loss of 117thinspmm after 5 years
Friberg and Jemt compared 280 TiUnite implants to 110
machined implants in 111 patients and found marginal
bone loss after 5 years to be 075 and 06thinspmm respectively
with no significant difference between the two types of
implants
Laser etching and Micro Arc Oxidation
After the implants are ultrasonically cleaned they are laser etched
by using an NdYAG laser at a power of 50kw frequency of 75khz
and 164A current
They are then processed in an electrolyte solution with 35
glyceroposphate disodium salt pentahydrate and 12 calcium
acetate monohydrate by microarc oxidation (voltage 350v
frequency 800hz) for 15 seconds
Microarc oxidation produces a titania film with a porous structure
and micropores of 1-5microm
The mechanism of osseointegration of the oxidized implants has
been shown to be mechanical interlocking and biochemical
bonding
Surface coating Ti Plasma Spray
Porous rough Ti surface have been fabricated by plasma
spraying a Ti powder form of molten droplets at high temperature
at temperature in order of 15000C at 600ms
The Ti plasma spray after solidification often provides 004 ndash 005
mm thickness
Ti A spray has been reported to increase the surface area of bone
to implant interface (as much as 600) and stimulate adhesion
osteogenesis
Advantages
Enhance attachment by increasing ionic interactions
Increased load bearing capability by 25-30
Increased tensile strength through ingrowth of bony tissues into 3D feature
Disadvantages
Cracking and scaling of coating because of stresses produced by elevated temprature processing
Risk of accumulation of abraded material in the interface zone during implantation of TPS
Hydroxyapatite coatings
Hydroxyapatite [Ca10(PO4)6OH]2 coating was brought to the
dental profession by DeGroot
HA forms a strong chemical bond with bone due to the presence
of free calcium and phosphate compounds at the implant surface
The HA coating consists of amorphous and crystalline forms with
a large density of cracks
The top 1-2 microm of the HA layer being amorphous while the rest
of the crystalline layer is hexagonally packed
Indicated Fresh extraction sites
Newly grafted sites
Advantages
1 Protection of surrounding bone against metal ion release from the
substrate
2 Reported chemical bonding between HA and living bone-intimate
contact-biointegration
3 Partial dissolution of HA makes surrounding fluid rich in calcium
and phosphate ions which trigger cellular differentiation and bone
formation
Disadvantages
Induction of impurities due to thermal decomposition during
processing- affecting long term clinical fixation
Dissolution of HA at lower pH
HA coating on the implant surface (50-70microm) by various methods
1 Plasma spraying
2 The vacuum deposition technique(ion beam sputtering radiofrequency
sputtering)
3 The sol gel and dip coating method
4 Electrolytic process
Nanotitania coatings
Nanotitania coatings were prepared by using the sol-gel
technique
Nanotitania implants had an increased feature density and a large
feature coverage area as compared to the nano-HA implants
This could present more binding sites for the protein cell
attachment and for increased bone contact
he Nanotitania implants exhibited an ordered arrangement
forming a homogenous layer on underlying topography
Biologically active drugs incorporated dental
implants
Bisphosphonates Bisphosphate-loaded implant surfaces have
been reported to improve implant osseointegration
Simvastatin
Simvastatin could induce the expression of bone morphogenetic
protein (BMP) mRNA that might promote bone formation and
increase bone mineral density
Gentamycin along with the layer of HA can be coated onto the
implant surface which may act as a local prophylactic agent along
with the systemic antibiotics in dental implant surgery
Biochemical Methods
of the Surface
Modifications
Biochemical Methods of the Surface
Modifications
Their goal is to immobilize proteins enzymes or peptides on
biomaterials for the purpose of inducing specific cell and tissue
responses
1 One approach uses cell-adhesion molecules like fibronectin
vitronectin Type I collagen osteogenin and bone sialoprotein
2 The second approach uses biomolecules with osteotropic
effects which range from mitogenicity (interleukin growth
factor-I FGF-2 platelet derived growth factor ndashBB) to the
increasing activity of the bone cells which enhances the
collagen synthesis for osteoinduction
Zirconia implants
Zirconia (Zr02) is a ceramic material used in implantology because
Biocompatibility(bio inert)
Esthetics (because its colour is similar to the teeth) and
Mechanical properties which are better than alumina
High resistance to corrosion flexion and fracture
Contact with bone and soft tissue similar to that observed in
titanium implants
It can be used to produce a entire implant or as a coating
Advantages of Zirconia Dental Implants
No dark colour of the metal showing through the gums
No corrosion of the zirconia as with titanium
No piezo-electric currents between dissimilar metal in
the mouth
It is thermally non-conductive
Greater BIC (Bone ndash Implant Contact)
20 more bone apposition than titanium implants
Zeynep Ouml zkurt Zirconia Dental Implants A Literature Review Journal of Oral Implantology Vol 37(3)2011
RTQ (removal torque testing) Gahlert et al evaluated the RTQ values of
machined zirconia implants sandblasted zirconia implants and SLA titanium
implants The mean RTQ for machined zirconia implants was 259 Ncm the
mean RTQ for zirconia rough implants was 405 Ncm and the mean RTQ for
SLA titanium implants was 1052 Ncm
Fracture strength within clinically acceptable limits
Stress analysis Kohal et al observed the stress distribution patterns of
zirconia implants (ReImplant) which were found to have low well distributed
and similar stress distribution compared with titanium implants
PEEK implants (poly etheretherketone)
These implants are available in three fundamentally different
designs
TAU Diameter -48 mm lengths 10 125 15 mm
immediate loading possible
Low density bone
THETA Similar to TAU but D1 bone
IOTA It is a 3mm diameter implant (10 and 12 mm)
used in narrow ridges
Advantages
Good strengthfracture resistance and bioinertness
Promotes human oseteoblast cell growth
Disadvantages
Faintly radiopaque ndashdifficult for post-op evaluation
Lengths and diameters range is restricted
Advances in
commercially
available implant
systems
LASER- LOK TECHNOLOGY
Unique surface characteristics
Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using
laser ablation technology
Extremely consistent microchannels that are optimally
sized to attach and organize both osteoblasts and
fibroblasts
Includes a repeating nanostructure that maximizes
surface area and enables cell pseudopodia and collagen
microfibrils to interdigitate with the Laser-Lok surface
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Clinical and Radiographic Evaluation of Braringnemark Implants with an
Anodized Surface following Seven-to-Eight Years of Functional Loading
David Gelb Bradley McaAllister et al Int J Dent 2013 2013 583567
The aim of this study was to evaluate the clinical and
radiographic long-term outcomes of dental implants with an
anodized TiUnite surface placed in routine clinical practice
38 single prosthesis
22 FPDs
80 implants in maxilla
27 in mandible
Mean marginal bone level change-149 plusmn 103 mm
907 of cases- no visible plaque93 -visible plaque
No prosthetic complication
Calandriello evaluated immediately placed anodized
implants in 33 patients and found a mean marginal bone
loss of 117thinspmm after 5 years
Friberg and Jemt compared 280 TiUnite implants to 110
machined implants in 111 patients and found marginal
bone loss after 5 years to be 075 and 06thinspmm respectively
with no significant difference between the two types of
implants
Laser etching and Micro Arc Oxidation
After the implants are ultrasonically cleaned they are laser etched
by using an NdYAG laser at a power of 50kw frequency of 75khz
and 164A current
They are then processed in an electrolyte solution with 35
glyceroposphate disodium salt pentahydrate and 12 calcium
acetate monohydrate by microarc oxidation (voltage 350v
frequency 800hz) for 15 seconds
Microarc oxidation produces a titania film with a porous structure
and micropores of 1-5microm
The mechanism of osseointegration of the oxidized implants has
been shown to be mechanical interlocking and biochemical
bonding
Surface coating Ti Plasma Spray
Porous rough Ti surface have been fabricated by plasma
spraying a Ti powder form of molten droplets at high temperature
at temperature in order of 15000C at 600ms
The Ti plasma spray after solidification often provides 004 ndash 005
mm thickness
Ti A spray has been reported to increase the surface area of bone
to implant interface (as much as 600) and stimulate adhesion
osteogenesis
Advantages
Enhance attachment by increasing ionic interactions
Increased load bearing capability by 25-30
Increased tensile strength through ingrowth of bony tissues into 3D feature
Disadvantages
Cracking and scaling of coating because of stresses produced by elevated temprature processing
Risk of accumulation of abraded material in the interface zone during implantation of TPS
Hydroxyapatite coatings
Hydroxyapatite [Ca10(PO4)6OH]2 coating was brought to the
dental profession by DeGroot
HA forms a strong chemical bond with bone due to the presence
of free calcium and phosphate compounds at the implant surface
The HA coating consists of amorphous and crystalline forms with
a large density of cracks
The top 1-2 microm of the HA layer being amorphous while the rest
of the crystalline layer is hexagonally packed
Indicated Fresh extraction sites
Newly grafted sites
Advantages
1 Protection of surrounding bone against metal ion release from the
substrate
2 Reported chemical bonding between HA and living bone-intimate
contact-biointegration
3 Partial dissolution of HA makes surrounding fluid rich in calcium
and phosphate ions which trigger cellular differentiation and bone
formation
Disadvantages
Induction of impurities due to thermal decomposition during
processing- affecting long term clinical fixation
Dissolution of HA at lower pH
HA coating on the implant surface (50-70microm) by various methods
1 Plasma spraying
2 The vacuum deposition technique(ion beam sputtering radiofrequency
sputtering)
3 The sol gel and dip coating method
4 Electrolytic process
Nanotitania coatings
Nanotitania coatings were prepared by using the sol-gel
technique
Nanotitania implants had an increased feature density and a large
feature coverage area as compared to the nano-HA implants
This could present more binding sites for the protein cell
attachment and for increased bone contact
he Nanotitania implants exhibited an ordered arrangement
forming a homogenous layer on underlying topography
Biologically active drugs incorporated dental
implants
Bisphosphonates Bisphosphate-loaded implant surfaces have
been reported to improve implant osseointegration
Simvastatin
Simvastatin could induce the expression of bone morphogenetic
protein (BMP) mRNA that might promote bone formation and
increase bone mineral density
Gentamycin along with the layer of HA can be coated onto the
implant surface which may act as a local prophylactic agent along
with the systemic antibiotics in dental implant surgery
Biochemical Methods
of the Surface
Modifications
Biochemical Methods of the Surface
Modifications
Their goal is to immobilize proteins enzymes or peptides on
biomaterials for the purpose of inducing specific cell and tissue
responses
1 One approach uses cell-adhesion molecules like fibronectin
vitronectin Type I collagen osteogenin and bone sialoprotein
2 The second approach uses biomolecules with osteotropic
effects which range from mitogenicity (interleukin growth
factor-I FGF-2 platelet derived growth factor ndashBB) to the
increasing activity of the bone cells which enhances the
collagen synthesis for osteoinduction
Zirconia implants
Zirconia (Zr02) is a ceramic material used in implantology because
Biocompatibility(bio inert)
Esthetics (because its colour is similar to the teeth) and
Mechanical properties which are better than alumina
High resistance to corrosion flexion and fracture
Contact with bone and soft tissue similar to that observed in
titanium implants
It can be used to produce a entire implant or as a coating
Advantages of Zirconia Dental Implants
No dark colour of the metal showing through the gums
No corrosion of the zirconia as with titanium
No piezo-electric currents between dissimilar metal in
the mouth
It is thermally non-conductive
Greater BIC (Bone ndash Implant Contact)
20 more bone apposition than titanium implants
Zeynep Ouml zkurt Zirconia Dental Implants A Literature Review Journal of Oral Implantology Vol 37(3)2011
RTQ (removal torque testing) Gahlert et al evaluated the RTQ values of
machined zirconia implants sandblasted zirconia implants and SLA titanium
implants The mean RTQ for machined zirconia implants was 259 Ncm the
mean RTQ for zirconia rough implants was 405 Ncm and the mean RTQ for
SLA titanium implants was 1052 Ncm
Fracture strength within clinically acceptable limits
Stress analysis Kohal et al observed the stress distribution patterns of
zirconia implants (ReImplant) which were found to have low well distributed
and similar stress distribution compared with titanium implants
PEEK implants (poly etheretherketone)
These implants are available in three fundamentally different
designs
TAU Diameter -48 mm lengths 10 125 15 mm
immediate loading possible
Low density bone
THETA Similar to TAU but D1 bone
IOTA It is a 3mm diameter implant (10 and 12 mm)
used in narrow ridges
Advantages
Good strengthfracture resistance and bioinertness
Promotes human oseteoblast cell growth
Disadvantages
Faintly radiopaque ndashdifficult for post-op evaluation
Lengths and diameters range is restricted
Advances in
commercially
available implant
systems
LASER- LOK TECHNOLOGY
Unique surface characteristics
Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using
laser ablation technology
Extremely consistent microchannels that are optimally
sized to attach and organize both osteoblasts and
fibroblasts
Includes a repeating nanostructure that maximizes
surface area and enables cell pseudopodia and collagen
microfibrils to interdigitate with the Laser-Lok surface
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Calandriello evaluated immediately placed anodized
implants in 33 patients and found a mean marginal bone
loss of 117thinspmm after 5 years
Friberg and Jemt compared 280 TiUnite implants to 110
machined implants in 111 patients and found marginal
bone loss after 5 years to be 075 and 06thinspmm respectively
with no significant difference between the two types of
implants
Laser etching and Micro Arc Oxidation
After the implants are ultrasonically cleaned they are laser etched
by using an NdYAG laser at a power of 50kw frequency of 75khz
and 164A current
They are then processed in an electrolyte solution with 35
glyceroposphate disodium salt pentahydrate and 12 calcium
acetate monohydrate by microarc oxidation (voltage 350v
frequency 800hz) for 15 seconds
Microarc oxidation produces a titania film with a porous structure
and micropores of 1-5microm
The mechanism of osseointegration of the oxidized implants has
been shown to be mechanical interlocking and biochemical
bonding
Surface coating Ti Plasma Spray
Porous rough Ti surface have been fabricated by plasma
spraying a Ti powder form of molten droplets at high temperature
at temperature in order of 15000C at 600ms
The Ti plasma spray after solidification often provides 004 ndash 005
mm thickness
Ti A spray has been reported to increase the surface area of bone
to implant interface (as much as 600) and stimulate adhesion
osteogenesis
Advantages
Enhance attachment by increasing ionic interactions
Increased load bearing capability by 25-30
Increased tensile strength through ingrowth of bony tissues into 3D feature
Disadvantages
Cracking and scaling of coating because of stresses produced by elevated temprature processing
Risk of accumulation of abraded material in the interface zone during implantation of TPS
Hydroxyapatite coatings
Hydroxyapatite [Ca10(PO4)6OH]2 coating was brought to the
dental profession by DeGroot
HA forms a strong chemical bond with bone due to the presence
of free calcium and phosphate compounds at the implant surface
The HA coating consists of amorphous and crystalline forms with
a large density of cracks
The top 1-2 microm of the HA layer being amorphous while the rest
of the crystalline layer is hexagonally packed
Indicated Fresh extraction sites
Newly grafted sites
Advantages
1 Protection of surrounding bone against metal ion release from the
substrate
2 Reported chemical bonding between HA and living bone-intimate
contact-biointegration
3 Partial dissolution of HA makes surrounding fluid rich in calcium
and phosphate ions which trigger cellular differentiation and bone
formation
Disadvantages
Induction of impurities due to thermal decomposition during
processing- affecting long term clinical fixation
Dissolution of HA at lower pH
HA coating on the implant surface (50-70microm) by various methods
1 Plasma spraying
2 The vacuum deposition technique(ion beam sputtering radiofrequency
sputtering)
3 The sol gel and dip coating method
4 Electrolytic process
Nanotitania coatings
Nanotitania coatings were prepared by using the sol-gel
technique
Nanotitania implants had an increased feature density and a large
feature coverage area as compared to the nano-HA implants
This could present more binding sites for the protein cell
attachment and for increased bone contact
he Nanotitania implants exhibited an ordered arrangement
forming a homogenous layer on underlying topography
Biologically active drugs incorporated dental
implants
Bisphosphonates Bisphosphate-loaded implant surfaces have
been reported to improve implant osseointegration
Simvastatin
Simvastatin could induce the expression of bone morphogenetic
protein (BMP) mRNA that might promote bone formation and
increase bone mineral density
Gentamycin along with the layer of HA can be coated onto the
implant surface which may act as a local prophylactic agent along
with the systemic antibiotics in dental implant surgery
Biochemical Methods
of the Surface
Modifications
Biochemical Methods of the Surface
Modifications
Their goal is to immobilize proteins enzymes or peptides on
biomaterials for the purpose of inducing specific cell and tissue
responses
1 One approach uses cell-adhesion molecules like fibronectin
vitronectin Type I collagen osteogenin and bone sialoprotein
2 The second approach uses biomolecules with osteotropic
effects which range from mitogenicity (interleukin growth
factor-I FGF-2 platelet derived growth factor ndashBB) to the
increasing activity of the bone cells which enhances the
collagen synthesis for osteoinduction
Zirconia implants
Zirconia (Zr02) is a ceramic material used in implantology because
Biocompatibility(bio inert)
Esthetics (because its colour is similar to the teeth) and
Mechanical properties which are better than alumina
High resistance to corrosion flexion and fracture
Contact with bone and soft tissue similar to that observed in
titanium implants
It can be used to produce a entire implant or as a coating
Advantages of Zirconia Dental Implants
No dark colour of the metal showing through the gums
No corrosion of the zirconia as with titanium
No piezo-electric currents between dissimilar metal in
the mouth
It is thermally non-conductive
Greater BIC (Bone ndash Implant Contact)
20 more bone apposition than titanium implants
Zeynep Ouml zkurt Zirconia Dental Implants A Literature Review Journal of Oral Implantology Vol 37(3)2011
RTQ (removal torque testing) Gahlert et al evaluated the RTQ values of
machined zirconia implants sandblasted zirconia implants and SLA titanium
implants The mean RTQ for machined zirconia implants was 259 Ncm the
mean RTQ for zirconia rough implants was 405 Ncm and the mean RTQ for
SLA titanium implants was 1052 Ncm
Fracture strength within clinically acceptable limits
Stress analysis Kohal et al observed the stress distribution patterns of
zirconia implants (ReImplant) which were found to have low well distributed
and similar stress distribution compared with titanium implants
PEEK implants (poly etheretherketone)
These implants are available in three fundamentally different
designs
TAU Diameter -48 mm lengths 10 125 15 mm
immediate loading possible
Low density bone
THETA Similar to TAU but D1 bone
IOTA It is a 3mm diameter implant (10 and 12 mm)
used in narrow ridges
Advantages
Good strengthfracture resistance and bioinertness
Promotes human oseteoblast cell growth
Disadvantages
Faintly radiopaque ndashdifficult for post-op evaluation
Lengths and diameters range is restricted
Advances in
commercially
available implant
systems
LASER- LOK TECHNOLOGY
Unique surface characteristics
Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using
laser ablation technology
Extremely consistent microchannels that are optimally
sized to attach and organize both osteoblasts and
fibroblasts
Includes a repeating nanostructure that maximizes
surface area and enables cell pseudopodia and collagen
microfibrils to interdigitate with the Laser-Lok surface
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Laser etching and Micro Arc Oxidation
After the implants are ultrasonically cleaned they are laser etched
by using an NdYAG laser at a power of 50kw frequency of 75khz
and 164A current
They are then processed in an electrolyte solution with 35
glyceroposphate disodium salt pentahydrate and 12 calcium
acetate monohydrate by microarc oxidation (voltage 350v
frequency 800hz) for 15 seconds
Microarc oxidation produces a titania film with a porous structure
and micropores of 1-5microm
The mechanism of osseointegration of the oxidized implants has
been shown to be mechanical interlocking and biochemical
bonding
Surface coating Ti Plasma Spray
Porous rough Ti surface have been fabricated by plasma
spraying a Ti powder form of molten droplets at high temperature
at temperature in order of 15000C at 600ms
The Ti plasma spray after solidification often provides 004 ndash 005
mm thickness
Ti A spray has been reported to increase the surface area of bone
to implant interface (as much as 600) and stimulate adhesion
osteogenesis
Advantages
Enhance attachment by increasing ionic interactions
Increased load bearing capability by 25-30
Increased tensile strength through ingrowth of bony tissues into 3D feature
Disadvantages
Cracking and scaling of coating because of stresses produced by elevated temprature processing
Risk of accumulation of abraded material in the interface zone during implantation of TPS
Hydroxyapatite coatings
Hydroxyapatite [Ca10(PO4)6OH]2 coating was brought to the
dental profession by DeGroot
HA forms a strong chemical bond with bone due to the presence
of free calcium and phosphate compounds at the implant surface
The HA coating consists of amorphous and crystalline forms with
a large density of cracks
The top 1-2 microm of the HA layer being amorphous while the rest
of the crystalline layer is hexagonally packed
Indicated Fresh extraction sites
Newly grafted sites
Advantages
1 Protection of surrounding bone against metal ion release from the
substrate
2 Reported chemical bonding between HA and living bone-intimate
contact-biointegration
3 Partial dissolution of HA makes surrounding fluid rich in calcium
and phosphate ions which trigger cellular differentiation and bone
formation
Disadvantages
Induction of impurities due to thermal decomposition during
processing- affecting long term clinical fixation
Dissolution of HA at lower pH
HA coating on the implant surface (50-70microm) by various methods
1 Plasma spraying
2 The vacuum deposition technique(ion beam sputtering radiofrequency
sputtering)
3 The sol gel and dip coating method
4 Electrolytic process
Nanotitania coatings
Nanotitania coatings were prepared by using the sol-gel
technique
Nanotitania implants had an increased feature density and a large
feature coverage area as compared to the nano-HA implants
This could present more binding sites for the protein cell
attachment and for increased bone contact
he Nanotitania implants exhibited an ordered arrangement
forming a homogenous layer on underlying topography
Biologically active drugs incorporated dental
implants
Bisphosphonates Bisphosphate-loaded implant surfaces have
been reported to improve implant osseointegration
Simvastatin
Simvastatin could induce the expression of bone morphogenetic
protein (BMP) mRNA that might promote bone formation and
increase bone mineral density
Gentamycin along with the layer of HA can be coated onto the
implant surface which may act as a local prophylactic agent along
with the systemic antibiotics in dental implant surgery
Biochemical Methods
of the Surface
Modifications
Biochemical Methods of the Surface
Modifications
Their goal is to immobilize proteins enzymes or peptides on
biomaterials for the purpose of inducing specific cell and tissue
responses
1 One approach uses cell-adhesion molecules like fibronectin
vitronectin Type I collagen osteogenin and bone sialoprotein
2 The second approach uses biomolecules with osteotropic
effects which range from mitogenicity (interleukin growth
factor-I FGF-2 platelet derived growth factor ndashBB) to the
increasing activity of the bone cells which enhances the
collagen synthesis for osteoinduction
Zirconia implants
Zirconia (Zr02) is a ceramic material used in implantology because
Biocompatibility(bio inert)
Esthetics (because its colour is similar to the teeth) and
Mechanical properties which are better than alumina
High resistance to corrosion flexion and fracture
Contact with bone and soft tissue similar to that observed in
titanium implants
It can be used to produce a entire implant or as a coating
Advantages of Zirconia Dental Implants
No dark colour of the metal showing through the gums
No corrosion of the zirconia as with titanium
No piezo-electric currents between dissimilar metal in
the mouth
It is thermally non-conductive
Greater BIC (Bone ndash Implant Contact)
20 more bone apposition than titanium implants
Zeynep Ouml zkurt Zirconia Dental Implants A Literature Review Journal of Oral Implantology Vol 37(3)2011
RTQ (removal torque testing) Gahlert et al evaluated the RTQ values of
machined zirconia implants sandblasted zirconia implants and SLA titanium
implants The mean RTQ for machined zirconia implants was 259 Ncm the
mean RTQ for zirconia rough implants was 405 Ncm and the mean RTQ for
SLA titanium implants was 1052 Ncm
Fracture strength within clinically acceptable limits
Stress analysis Kohal et al observed the stress distribution patterns of
zirconia implants (ReImplant) which were found to have low well distributed
and similar stress distribution compared with titanium implants
PEEK implants (poly etheretherketone)
These implants are available in three fundamentally different
designs
TAU Diameter -48 mm lengths 10 125 15 mm
immediate loading possible
Low density bone
THETA Similar to TAU but D1 bone
IOTA It is a 3mm diameter implant (10 and 12 mm)
used in narrow ridges
Advantages
Good strengthfracture resistance and bioinertness
Promotes human oseteoblast cell growth
Disadvantages
Faintly radiopaque ndashdifficult for post-op evaluation
Lengths and diameters range is restricted
Advances in
commercially
available implant
systems
LASER- LOK TECHNOLOGY
Unique surface characteristics
Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using
laser ablation technology
Extremely consistent microchannels that are optimally
sized to attach and organize both osteoblasts and
fibroblasts
Includes a repeating nanostructure that maximizes
surface area and enables cell pseudopodia and collagen
microfibrils to interdigitate with the Laser-Lok surface
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Surface coating Ti Plasma Spray
Porous rough Ti surface have been fabricated by plasma
spraying a Ti powder form of molten droplets at high temperature
at temperature in order of 15000C at 600ms
The Ti plasma spray after solidification often provides 004 ndash 005
mm thickness
Ti A spray has been reported to increase the surface area of bone
to implant interface (as much as 600) and stimulate adhesion
osteogenesis
Advantages
Enhance attachment by increasing ionic interactions
Increased load bearing capability by 25-30
Increased tensile strength through ingrowth of bony tissues into 3D feature
Disadvantages
Cracking and scaling of coating because of stresses produced by elevated temprature processing
Risk of accumulation of abraded material in the interface zone during implantation of TPS
Hydroxyapatite coatings
Hydroxyapatite [Ca10(PO4)6OH]2 coating was brought to the
dental profession by DeGroot
HA forms a strong chemical bond with bone due to the presence
of free calcium and phosphate compounds at the implant surface
The HA coating consists of amorphous and crystalline forms with
a large density of cracks
The top 1-2 microm of the HA layer being amorphous while the rest
of the crystalline layer is hexagonally packed
Indicated Fresh extraction sites
Newly grafted sites
Advantages
1 Protection of surrounding bone against metal ion release from the
substrate
2 Reported chemical bonding between HA and living bone-intimate
contact-biointegration
3 Partial dissolution of HA makes surrounding fluid rich in calcium
and phosphate ions which trigger cellular differentiation and bone
formation
Disadvantages
Induction of impurities due to thermal decomposition during
processing- affecting long term clinical fixation
Dissolution of HA at lower pH
HA coating on the implant surface (50-70microm) by various methods
1 Plasma spraying
2 The vacuum deposition technique(ion beam sputtering radiofrequency
sputtering)
3 The sol gel and dip coating method
4 Electrolytic process
Nanotitania coatings
Nanotitania coatings were prepared by using the sol-gel
technique
Nanotitania implants had an increased feature density and a large
feature coverage area as compared to the nano-HA implants
This could present more binding sites for the protein cell
attachment and for increased bone contact
he Nanotitania implants exhibited an ordered arrangement
forming a homogenous layer on underlying topography
Biologically active drugs incorporated dental
implants
Bisphosphonates Bisphosphate-loaded implant surfaces have
been reported to improve implant osseointegration
Simvastatin
Simvastatin could induce the expression of bone morphogenetic
protein (BMP) mRNA that might promote bone formation and
increase bone mineral density
Gentamycin along with the layer of HA can be coated onto the
implant surface which may act as a local prophylactic agent along
with the systemic antibiotics in dental implant surgery
Biochemical Methods
of the Surface
Modifications
Biochemical Methods of the Surface
Modifications
Their goal is to immobilize proteins enzymes or peptides on
biomaterials for the purpose of inducing specific cell and tissue
responses
1 One approach uses cell-adhesion molecules like fibronectin
vitronectin Type I collagen osteogenin and bone sialoprotein
2 The second approach uses biomolecules with osteotropic
effects which range from mitogenicity (interleukin growth
factor-I FGF-2 platelet derived growth factor ndashBB) to the
increasing activity of the bone cells which enhances the
collagen synthesis for osteoinduction
Zirconia implants
Zirconia (Zr02) is a ceramic material used in implantology because
Biocompatibility(bio inert)
Esthetics (because its colour is similar to the teeth) and
Mechanical properties which are better than alumina
High resistance to corrosion flexion and fracture
Contact with bone and soft tissue similar to that observed in
titanium implants
It can be used to produce a entire implant or as a coating
Advantages of Zirconia Dental Implants
No dark colour of the metal showing through the gums
No corrosion of the zirconia as with titanium
No piezo-electric currents between dissimilar metal in
the mouth
It is thermally non-conductive
Greater BIC (Bone ndash Implant Contact)
20 more bone apposition than titanium implants
Zeynep Ouml zkurt Zirconia Dental Implants A Literature Review Journal of Oral Implantology Vol 37(3)2011
RTQ (removal torque testing) Gahlert et al evaluated the RTQ values of
machined zirconia implants sandblasted zirconia implants and SLA titanium
implants The mean RTQ for machined zirconia implants was 259 Ncm the
mean RTQ for zirconia rough implants was 405 Ncm and the mean RTQ for
SLA titanium implants was 1052 Ncm
Fracture strength within clinically acceptable limits
Stress analysis Kohal et al observed the stress distribution patterns of
zirconia implants (ReImplant) which were found to have low well distributed
and similar stress distribution compared with titanium implants
PEEK implants (poly etheretherketone)
These implants are available in three fundamentally different
designs
TAU Diameter -48 mm lengths 10 125 15 mm
immediate loading possible
Low density bone
THETA Similar to TAU but D1 bone
IOTA It is a 3mm diameter implant (10 and 12 mm)
used in narrow ridges
Advantages
Good strengthfracture resistance and bioinertness
Promotes human oseteoblast cell growth
Disadvantages
Faintly radiopaque ndashdifficult for post-op evaluation
Lengths and diameters range is restricted
Advances in
commercially
available implant
systems
LASER- LOK TECHNOLOGY
Unique surface characteristics
Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using
laser ablation technology
Extremely consistent microchannels that are optimally
sized to attach and organize both osteoblasts and
fibroblasts
Includes a repeating nanostructure that maximizes
surface area and enables cell pseudopodia and collagen
microfibrils to interdigitate with the Laser-Lok surface
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Advantages
Enhance attachment by increasing ionic interactions
Increased load bearing capability by 25-30
Increased tensile strength through ingrowth of bony tissues into 3D feature
Disadvantages
Cracking and scaling of coating because of stresses produced by elevated temprature processing
Risk of accumulation of abraded material in the interface zone during implantation of TPS
Hydroxyapatite coatings
Hydroxyapatite [Ca10(PO4)6OH]2 coating was brought to the
dental profession by DeGroot
HA forms a strong chemical bond with bone due to the presence
of free calcium and phosphate compounds at the implant surface
The HA coating consists of amorphous and crystalline forms with
a large density of cracks
The top 1-2 microm of the HA layer being amorphous while the rest
of the crystalline layer is hexagonally packed
Indicated Fresh extraction sites
Newly grafted sites
Advantages
1 Protection of surrounding bone against metal ion release from the
substrate
2 Reported chemical bonding between HA and living bone-intimate
contact-biointegration
3 Partial dissolution of HA makes surrounding fluid rich in calcium
and phosphate ions which trigger cellular differentiation and bone
formation
Disadvantages
Induction of impurities due to thermal decomposition during
processing- affecting long term clinical fixation
Dissolution of HA at lower pH
HA coating on the implant surface (50-70microm) by various methods
1 Plasma spraying
2 The vacuum deposition technique(ion beam sputtering radiofrequency
sputtering)
3 The sol gel and dip coating method
4 Electrolytic process
Nanotitania coatings
Nanotitania coatings were prepared by using the sol-gel
technique
Nanotitania implants had an increased feature density and a large
feature coverage area as compared to the nano-HA implants
This could present more binding sites for the protein cell
attachment and for increased bone contact
he Nanotitania implants exhibited an ordered arrangement
forming a homogenous layer on underlying topography
Biologically active drugs incorporated dental
implants
Bisphosphonates Bisphosphate-loaded implant surfaces have
been reported to improve implant osseointegration
Simvastatin
Simvastatin could induce the expression of bone morphogenetic
protein (BMP) mRNA that might promote bone formation and
increase bone mineral density
Gentamycin along with the layer of HA can be coated onto the
implant surface which may act as a local prophylactic agent along
with the systemic antibiotics in dental implant surgery
Biochemical Methods
of the Surface
Modifications
Biochemical Methods of the Surface
Modifications
Their goal is to immobilize proteins enzymes or peptides on
biomaterials for the purpose of inducing specific cell and tissue
responses
1 One approach uses cell-adhesion molecules like fibronectin
vitronectin Type I collagen osteogenin and bone sialoprotein
2 The second approach uses biomolecules with osteotropic
effects which range from mitogenicity (interleukin growth
factor-I FGF-2 platelet derived growth factor ndashBB) to the
increasing activity of the bone cells which enhances the
collagen synthesis for osteoinduction
Zirconia implants
Zirconia (Zr02) is a ceramic material used in implantology because
Biocompatibility(bio inert)
Esthetics (because its colour is similar to the teeth) and
Mechanical properties which are better than alumina
High resistance to corrosion flexion and fracture
Contact with bone and soft tissue similar to that observed in
titanium implants
It can be used to produce a entire implant or as a coating
Advantages of Zirconia Dental Implants
No dark colour of the metal showing through the gums
No corrosion of the zirconia as with titanium
No piezo-electric currents between dissimilar metal in
the mouth
It is thermally non-conductive
Greater BIC (Bone ndash Implant Contact)
20 more bone apposition than titanium implants
Zeynep Ouml zkurt Zirconia Dental Implants A Literature Review Journal of Oral Implantology Vol 37(3)2011
RTQ (removal torque testing) Gahlert et al evaluated the RTQ values of
machined zirconia implants sandblasted zirconia implants and SLA titanium
implants The mean RTQ for machined zirconia implants was 259 Ncm the
mean RTQ for zirconia rough implants was 405 Ncm and the mean RTQ for
SLA titanium implants was 1052 Ncm
Fracture strength within clinically acceptable limits
Stress analysis Kohal et al observed the stress distribution patterns of
zirconia implants (ReImplant) which were found to have low well distributed
and similar stress distribution compared with titanium implants
PEEK implants (poly etheretherketone)
These implants are available in three fundamentally different
designs
TAU Diameter -48 mm lengths 10 125 15 mm
immediate loading possible
Low density bone
THETA Similar to TAU but D1 bone
IOTA It is a 3mm diameter implant (10 and 12 mm)
used in narrow ridges
Advantages
Good strengthfracture resistance and bioinertness
Promotes human oseteoblast cell growth
Disadvantages
Faintly radiopaque ndashdifficult for post-op evaluation
Lengths and diameters range is restricted
Advances in
commercially
available implant
systems
LASER- LOK TECHNOLOGY
Unique surface characteristics
Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using
laser ablation technology
Extremely consistent microchannels that are optimally
sized to attach and organize both osteoblasts and
fibroblasts
Includes a repeating nanostructure that maximizes
surface area and enables cell pseudopodia and collagen
microfibrils to interdigitate with the Laser-Lok surface
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Hydroxyapatite coatings
Hydroxyapatite [Ca10(PO4)6OH]2 coating was brought to the
dental profession by DeGroot
HA forms a strong chemical bond with bone due to the presence
of free calcium and phosphate compounds at the implant surface
The HA coating consists of amorphous and crystalline forms with
a large density of cracks
The top 1-2 microm of the HA layer being amorphous while the rest
of the crystalline layer is hexagonally packed
Indicated Fresh extraction sites
Newly grafted sites
Advantages
1 Protection of surrounding bone against metal ion release from the
substrate
2 Reported chemical bonding between HA and living bone-intimate
contact-biointegration
3 Partial dissolution of HA makes surrounding fluid rich in calcium
and phosphate ions which trigger cellular differentiation and bone
formation
Disadvantages
Induction of impurities due to thermal decomposition during
processing- affecting long term clinical fixation
Dissolution of HA at lower pH
HA coating on the implant surface (50-70microm) by various methods
1 Plasma spraying
2 The vacuum deposition technique(ion beam sputtering radiofrequency
sputtering)
3 The sol gel and dip coating method
4 Electrolytic process
Nanotitania coatings
Nanotitania coatings were prepared by using the sol-gel
technique
Nanotitania implants had an increased feature density and a large
feature coverage area as compared to the nano-HA implants
This could present more binding sites for the protein cell
attachment and for increased bone contact
he Nanotitania implants exhibited an ordered arrangement
forming a homogenous layer on underlying topography
Biologically active drugs incorporated dental
implants
Bisphosphonates Bisphosphate-loaded implant surfaces have
been reported to improve implant osseointegration
Simvastatin
Simvastatin could induce the expression of bone morphogenetic
protein (BMP) mRNA that might promote bone formation and
increase bone mineral density
Gentamycin along with the layer of HA can be coated onto the
implant surface which may act as a local prophylactic agent along
with the systemic antibiotics in dental implant surgery
Biochemical Methods
of the Surface
Modifications
Biochemical Methods of the Surface
Modifications
Their goal is to immobilize proteins enzymes or peptides on
biomaterials for the purpose of inducing specific cell and tissue
responses
1 One approach uses cell-adhesion molecules like fibronectin
vitronectin Type I collagen osteogenin and bone sialoprotein
2 The second approach uses biomolecules with osteotropic
effects which range from mitogenicity (interleukin growth
factor-I FGF-2 platelet derived growth factor ndashBB) to the
increasing activity of the bone cells which enhances the
collagen synthesis for osteoinduction
Zirconia implants
Zirconia (Zr02) is a ceramic material used in implantology because
Biocompatibility(bio inert)
Esthetics (because its colour is similar to the teeth) and
Mechanical properties which are better than alumina
High resistance to corrosion flexion and fracture
Contact with bone and soft tissue similar to that observed in
titanium implants
It can be used to produce a entire implant or as a coating
Advantages of Zirconia Dental Implants
No dark colour of the metal showing through the gums
No corrosion of the zirconia as with titanium
No piezo-electric currents between dissimilar metal in
the mouth
It is thermally non-conductive
Greater BIC (Bone ndash Implant Contact)
20 more bone apposition than titanium implants
Zeynep Ouml zkurt Zirconia Dental Implants A Literature Review Journal of Oral Implantology Vol 37(3)2011
RTQ (removal torque testing) Gahlert et al evaluated the RTQ values of
machined zirconia implants sandblasted zirconia implants and SLA titanium
implants The mean RTQ for machined zirconia implants was 259 Ncm the
mean RTQ for zirconia rough implants was 405 Ncm and the mean RTQ for
SLA titanium implants was 1052 Ncm
Fracture strength within clinically acceptable limits
Stress analysis Kohal et al observed the stress distribution patterns of
zirconia implants (ReImplant) which were found to have low well distributed
and similar stress distribution compared with titanium implants
PEEK implants (poly etheretherketone)
These implants are available in three fundamentally different
designs
TAU Diameter -48 mm lengths 10 125 15 mm
immediate loading possible
Low density bone
THETA Similar to TAU but D1 bone
IOTA It is a 3mm diameter implant (10 and 12 mm)
used in narrow ridges
Advantages
Good strengthfracture resistance and bioinertness
Promotes human oseteoblast cell growth
Disadvantages
Faintly radiopaque ndashdifficult for post-op evaluation
Lengths and diameters range is restricted
Advances in
commercially
available implant
systems
LASER- LOK TECHNOLOGY
Unique surface characteristics
Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using
laser ablation technology
Extremely consistent microchannels that are optimally
sized to attach and organize both osteoblasts and
fibroblasts
Includes a repeating nanostructure that maximizes
surface area and enables cell pseudopodia and collagen
microfibrils to interdigitate with the Laser-Lok surface
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Indicated Fresh extraction sites
Newly grafted sites
Advantages
1 Protection of surrounding bone against metal ion release from the
substrate
2 Reported chemical bonding between HA and living bone-intimate
contact-biointegration
3 Partial dissolution of HA makes surrounding fluid rich in calcium
and phosphate ions which trigger cellular differentiation and bone
formation
Disadvantages
Induction of impurities due to thermal decomposition during
processing- affecting long term clinical fixation
Dissolution of HA at lower pH
HA coating on the implant surface (50-70microm) by various methods
1 Plasma spraying
2 The vacuum deposition technique(ion beam sputtering radiofrequency
sputtering)
3 The sol gel and dip coating method
4 Electrolytic process
Nanotitania coatings
Nanotitania coatings were prepared by using the sol-gel
technique
Nanotitania implants had an increased feature density and a large
feature coverage area as compared to the nano-HA implants
This could present more binding sites for the protein cell
attachment and for increased bone contact
he Nanotitania implants exhibited an ordered arrangement
forming a homogenous layer on underlying topography
Biologically active drugs incorporated dental
implants
Bisphosphonates Bisphosphate-loaded implant surfaces have
been reported to improve implant osseointegration
Simvastatin
Simvastatin could induce the expression of bone morphogenetic
protein (BMP) mRNA that might promote bone formation and
increase bone mineral density
Gentamycin along with the layer of HA can be coated onto the
implant surface which may act as a local prophylactic agent along
with the systemic antibiotics in dental implant surgery
Biochemical Methods
of the Surface
Modifications
Biochemical Methods of the Surface
Modifications
Their goal is to immobilize proteins enzymes or peptides on
biomaterials for the purpose of inducing specific cell and tissue
responses
1 One approach uses cell-adhesion molecules like fibronectin
vitronectin Type I collagen osteogenin and bone sialoprotein
2 The second approach uses biomolecules with osteotropic
effects which range from mitogenicity (interleukin growth
factor-I FGF-2 platelet derived growth factor ndashBB) to the
increasing activity of the bone cells which enhances the
collagen synthesis for osteoinduction
Zirconia implants
Zirconia (Zr02) is a ceramic material used in implantology because
Biocompatibility(bio inert)
Esthetics (because its colour is similar to the teeth) and
Mechanical properties which are better than alumina
High resistance to corrosion flexion and fracture
Contact with bone and soft tissue similar to that observed in
titanium implants
It can be used to produce a entire implant or as a coating
Advantages of Zirconia Dental Implants
No dark colour of the metal showing through the gums
No corrosion of the zirconia as with titanium
No piezo-electric currents between dissimilar metal in
the mouth
It is thermally non-conductive
Greater BIC (Bone ndash Implant Contact)
20 more bone apposition than titanium implants
Zeynep Ouml zkurt Zirconia Dental Implants A Literature Review Journal of Oral Implantology Vol 37(3)2011
RTQ (removal torque testing) Gahlert et al evaluated the RTQ values of
machined zirconia implants sandblasted zirconia implants and SLA titanium
implants The mean RTQ for machined zirconia implants was 259 Ncm the
mean RTQ for zirconia rough implants was 405 Ncm and the mean RTQ for
SLA titanium implants was 1052 Ncm
Fracture strength within clinically acceptable limits
Stress analysis Kohal et al observed the stress distribution patterns of
zirconia implants (ReImplant) which were found to have low well distributed
and similar stress distribution compared with titanium implants
PEEK implants (poly etheretherketone)
These implants are available in three fundamentally different
designs
TAU Diameter -48 mm lengths 10 125 15 mm
immediate loading possible
Low density bone
THETA Similar to TAU but D1 bone
IOTA It is a 3mm diameter implant (10 and 12 mm)
used in narrow ridges
Advantages
Good strengthfracture resistance and bioinertness
Promotes human oseteoblast cell growth
Disadvantages
Faintly radiopaque ndashdifficult for post-op evaluation
Lengths and diameters range is restricted
Advances in
commercially
available implant
systems
LASER- LOK TECHNOLOGY
Unique surface characteristics
Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using
laser ablation technology
Extremely consistent microchannels that are optimally
sized to attach and organize both osteoblasts and
fibroblasts
Includes a repeating nanostructure that maximizes
surface area and enables cell pseudopodia and collagen
microfibrils to interdigitate with the Laser-Lok surface
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Disadvantages
Induction of impurities due to thermal decomposition during
processing- affecting long term clinical fixation
Dissolution of HA at lower pH
HA coating on the implant surface (50-70microm) by various methods
1 Plasma spraying
2 The vacuum deposition technique(ion beam sputtering radiofrequency
sputtering)
3 The sol gel and dip coating method
4 Electrolytic process
Nanotitania coatings
Nanotitania coatings were prepared by using the sol-gel
technique
Nanotitania implants had an increased feature density and a large
feature coverage area as compared to the nano-HA implants
This could present more binding sites for the protein cell
attachment and for increased bone contact
he Nanotitania implants exhibited an ordered arrangement
forming a homogenous layer on underlying topography
Biologically active drugs incorporated dental
implants
Bisphosphonates Bisphosphate-loaded implant surfaces have
been reported to improve implant osseointegration
Simvastatin
Simvastatin could induce the expression of bone morphogenetic
protein (BMP) mRNA that might promote bone formation and
increase bone mineral density
Gentamycin along with the layer of HA can be coated onto the
implant surface which may act as a local prophylactic agent along
with the systemic antibiotics in dental implant surgery
Biochemical Methods
of the Surface
Modifications
Biochemical Methods of the Surface
Modifications
Their goal is to immobilize proteins enzymes or peptides on
biomaterials for the purpose of inducing specific cell and tissue
responses
1 One approach uses cell-adhesion molecules like fibronectin
vitronectin Type I collagen osteogenin and bone sialoprotein
2 The second approach uses biomolecules with osteotropic
effects which range from mitogenicity (interleukin growth
factor-I FGF-2 platelet derived growth factor ndashBB) to the
increasing activity of the bone cells which enhances the
collagen synthesis for osteoinduction
Zirconia implants
Zirconia (Zr02) is a ceramic material used in implantology because
Biocompatibility(bio inert)
Esthetics (because its colour is similar to the teeth) and
Mechanical properties which are better than alumina
High resistance to corrosion flexion and fracture
Contact with bone and soft tissue similar to that observed in
titanium implants
It can be used to produce a entire implant or as a coating
Advantages of Zirconia Dental Implants
No dark colour of the metal showing through the gums
No corrosion of the zirconia as with titanium
No piezo-electric currents between dissimilar metal in
the mouth
It is thermally non-conductive
Greater BIC (Bone ndash Implant Contact)
20 more bone apposition than titanium implants
Zeynep Ouml zkurt Zirconia Dental Implants A Literature Review Journal of Oral Implantology Vol 37(3)2011
RTQ (removal torque testing) Gahlert et al evaluated the RTQ values of
machined zirconia implants sandblasted zirconia implants and SLA titanium
implants The mean RTQ for machined zirconia implants was 259 Ncm the
mean RTQ for zirconia rough implants was 405 Ncm and the mean RTQ for
SLA titanium implants was 1052 Ncm
Fracture strength within clinically acceptable limits
Stress analysis Kohal et al observed the stress distribution patterns of
zirconia implants (ReImplant) which were found to have low well distributed
and similar stress distribution compared with titanium implants
PEEK implants (poly etheretherketone)
These implants are available in three fundamentally different
designs
TAU Diameter -48 mm lengths 10 125 15 mm
immediate loading possible
Low density bone
THETA Similar to TAU but D1 bone
IOTA It is a 3mm diameter implant (10 and 12 mm)
used in narrow ridges
Advantages
Good strengthfracture resistance and bioinertness
Promotes human oseteoblast cell growth
Disadvantages
Faintly radiopaque ndashdifficult for post-op evaluation
Lengths and diameters range is restricted
Advances in
commercially
available implant
systems
LASER- LOK TECHNOLOGY
Unique surface characteristics
Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using
laser ablation technology
Extremely consistent microchannels that are optimally
sized to attach and organize both osteoblasts and
fibroblasts
Includes a repeating nanostructure that maximizes
surface area and enables cell pseudopodia and collagen
microfibrils to interdigitate with the Laser-Lok surface
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Nanotitania coatings
Nanotitania coatings were prepared by using the sol-gel
technique
Nanotitania implants had an increased feature density and a large
feature coverage area as compared to the nano-HA implants
This could present more binding sites for the protein cell
attachment and for increased bone contact
he Nanotitania implants exhibited an ordered arrangement
forming a homogenous layer on underlying topography
Biologically active drugs incorporated dental
implants
Bisphosphonates Bisphosphate-loaded implant surfaces have
been reported to improve implant osseointegration
Simvastatin
Simvastatin could induce the expression of bone morphogenetic
protein (BMP) mRNA that might promote bone formation and
increase bone mineral density
Gentamycin along with the layer of HA can be coated onto the
implant surface which may act as a local prophylactic agent along
with the systemic antibiotics in dental implant surgery
Biochemical Methods
of the Surface
Modifications
Biochemical Methods of the Surface
Modifications
Their goal is to immobilize proteins enzymes or peptides on
biomaterials for the purpose of inducing specific cell and tissue
responses
1 One approach uses cell-adhesion molecules like fibronectin
vitronectin Type I collagen osteogenin and bone sialoprotein
2 The second approach uses biomolecules with osteotropic
effects which range from mitogenicity (interleukin growth
factor-I FGF-2 platelet derived growth factor ndashBB) to the
increasing activity of the bone cells which enhances the
collagen synthesis for osteoinduction
Zirconia implants
Zirconia (Zr02) is a ceramic material used in implantology because
Biocompatibility(bio inert)
Esthetics (because its colour is similar to the teeth) and
Mechanical properties which are better than alumina
High resistance to corrosion flexion and fracture
Contact with bone and soft tissue similar to that observed in
titanium implants
It can be used to produce a entire implant or as a coating
Advantages of Zirconia Dental Implants
No dark colour of the metal showing through the gums
No corrosion of the zirconia as with titanium
No piezo-electric currents between dissimilar metal in
the mouth
It is thermally non-conductive
Greater BIC (Bone ndash Implant Contact)
20 more bone apposition than titanium implants
Zeynep Ouml zkurt Zirconia Dental Implants A Literature Review Journal of Oral Implantology Vol 37(3)2011
RTQ (removal torque testing) Gahlert et al evaluated the RTQ values of
machined zirconia implants sandblasted zirconia implants and SLA titanium
implants The mean RTQ for machined zirconia implants was 259 Ncm the
mean RTQ for zirconia rough implants was 405 Ncm and the mean RTQ for
SLA titanium implants was 1052 Ncm
Fracture strength within clinically acceptable limits
Stress analysis Kohal et al observed the stress distribution patterns of
zirconia implants (ReImplant) which were found to have low well distributed
and similar stress distribution compared with titanium implants
PEEK implants (poly etheretherketone)
These implants are available in three fundamentally different
designs
TAU Diameter -48 mm lengths 10 125 15 mm
immediate loading possible
Low density bone
THETA Similar to TAU but D1 bone
IOTA It is a 3mm diameter implant (10 and 12 mm)
used in narrow ridges
Advantages
Good strengthfracture resistance and bioinertness
Promotes human oseteoblast cell growth
Disadvantages
Faintly radiopaque ndashdifficult for post-op evaluation
Lengths and diameters range is restricted
Advances in
commercially
available implant
systems
LASER- LOK TECHNOLOGY
Unique surface characteristics
Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using
laser ablation technology
Extremely consistent microchannels that are optimally
sized to attach and organize both osteoblasts and
fibroblasts
Includes a repeating nanostructure that maximizes
surface area and enables cell pseudopodia and collagen
microfibrils to interdigitate with the Laser-Lok surface
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Biologically active drugs incorporated dental
implants
Bisphosphonates Bisphosphate-loaded implant surfaces have
been reported to improve implant osseointegration
Simvastatin
Simvastatin could induce the expression of bone morphogenetic
protein (BMP) mRNA that might promote bone formation and
increase bone mineral density
Gentamycin along with the layer of HA can be coated onto the
implant surface which may act as a local prophylactic agent along
with the systemic antibiotics in dental implant surgery
Biochemical Methods
of the Surface
Modifications
Biochemical Methods of the Surface
Modifications
Their goal is to immobilize proteins enzymes or peptides on
biomaterials for the purpose of inducing specific cell and tissue
responses
1 One approach uses cell-adhesion molecules like fibronectin
vitronectin Type I collagen osteogenin and bone sialoprotein
2 The second approach uses biomolecules with osteotropic
effects which range from mitogenicity (interleukin growth
factor-I FGF-2 platelet derived growth factor ndashBB) to the
increasing activity of the bone cells which enhances the
collagen synthesis for osteoinduction
Zirconia implants
Zirconia (Zr02) is a ceramic material used in implantology because
Biocompatibility(bio inert)
Esthetics (because its colour is similar to the teeth) and
Mechanical properties which are better than alumina
High resistance to corrosion flexion and fracture
Contact with bone and soft tissue similar to that observed in
titanium implants
It can be used to produce a entire implant or as a coating
Advantages of Zirconia Dental Implants
No dark colour of the metal showing through the gums
No corrosion of the zirconia as with titanium
No piezo-electric currents between dissimilar metal in
the mouth
It is thermally non-conductive
Greater BIC (Bone ndash Implant Contact)
20 more bone apposition than titanium implants
Zeynep Ouml zkurt Zirconia Dental Implants A Literature Review Journal of Oral Implantology Vol 37(3)2011
RTQ (removal torque testing) Gahlert et al evaluated the RTQ values of
machined zirconia implants sandblasted zirconia implants and SLA titanium
implants The mean RTQ for machined zirconia implants was 259 Ncm the
mean RTQ for zirconia rough implants was 405 Ncm and the mean RTQ for
SLA titanium implants was 1052 Ncm
Fracture strength within clinically acceptable limits
Stress analysis Kohal et al observed the stress distribution patterns of
zirconia implants (ReImplant) which were found to have low well distributed
and similar stress distribution compared with titanium implants
PEEK implants (poly etheretherketone)
These implants are available in three fundamentally different
designs
TAU Diameter -48 mm lengths 10 125 15 mm
immediate loading possible
Low density bone
THETA Similar to TAU but D1 bone
IOTA It is a 3mm diameter implant (10 and 12 mm)
used in narrow ridges
Advantages
Good strengthfracture resistance and bioinertness
Promotes human oseteoblast cell growth
Disadvantages
Faintly radiopaque ndashdifficult for post-op evaluation
Lengths and diameters range is restricted
Advances in
commercially
available implant
systems
LASER- LOK TECHNOLOGY
Unique surface characteristics
Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using
laser ablation technology
Extremely consistent microchannels that are optimally
sized to attach and organize both osteoblasts and
fibroblasts
Includes a repeating nanostructure that maximizes
surface area and enables cell pseudopodia and collagen
microfibrils to interdigitate with the Laser-Lok surface
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Biochemical Methods
of the Surface
Modifications
Biochemical Methods of the Surface
Modifications
Their goal is to immobilize proteins enzymes or peptides on
biomaterials for the purpose of inducing specific cell and tissue
responses
1 One approach uses cell-adhesion molecules like fibronectin
vitronectin Type I collagen osteogenin and bone sialoprotein
2 The second approach uses biomolecules with osteotropic
effects which range from mitogenicity (interleukin growth
factor-I FGF-2 platelet derived growth factor ndashBB) to the
increasing activity of the bone cells which enhances the
collagen synthesis for osteoinduction
Zirconia implants
Zirconia (Zr02) is a ceramic material used in implantology because
Biocompatibility(bio inert)
Esthetics (because its colour is similar to the teeth) and
Mechanical properties which are better than alumina
High resistance to corrosion flexion and fracture
Contact with bone and soft tissue similar to that observed in
titanium implants
It can be used to produce a entire implant or as a coating
Advantages of Zirconia Dental Implants
No dark colour of the metal showing through the gums
No corrosion of the zirconia as with titanium
No piezo-electric currents between dissimilar metal in
the mouth
It is thermally non-conductive
Greater BIC (Bone ndash Implant Contact)
20 more bone apposition than titanium implants
Zeynep Ouml zkurt Zirconia Dental Implants A Literature Review Journal of Oral Implantology Vol 37(3)2011
RTQ (removal torque testing) Gahlert et al evaluated the RTQ values of
machined zirconia implants sandblasted zirconia implants and SLA titanium
implants The mean RTQ for machined zirconia implants was 259 Ncm the
mean RTQ for zirconia rough implants was 405 Ncm and the mean RTQ for
SLA titanium implants was 1052 Ncm
Fracture strength within clinically acceptable limits
Stress analysis Kohal et al observed the stress distribution patterns of
zirconia implants (ReImplant) which were found to have low well distributed
and similar stress distribution compared with titanium implants
PEEK implants (poly etheretherketone)
These implants are available in three fundamentally different
designs
TAU Diameter -48 mm lengths 10 125 15 mm
immediate loading possible
Low density bone
THETA Similar to TAU but D1 bone
IOTA It is a 3mm diameter implant (10 and 12 mm)
used in narrow ridges
Advantages
Good strengthfracture resistance and bioinertness
Promotes human oseteoblast cell growth
Disadvantages
Faintly radiopaque ndashdifficult for post-op evaluation
Lengths and diameters range is restricted
Advances in
commercially
available implant
systems
LASER- LOK TECHNOLOGY
Unique surface characteristics
Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using
laser ablation technology
Extremely consistent microchannels that are optimally
sized to attach and organize both osteoblasts and
fibroblasts
Includes a repeating nanostructure that maximizes
surface area and enables cell pseudopodia and collagen
microfibrils to interdigitate with the Laser-Lok surface
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Biochemical Methods of the Surface
Modifications
Their goal is to immobilize proteins enzymes or peptides on
biomaterials for the purpose of inducing specific cell and tissue
responses
1 One approach uses cell-adhesion molecules like fibronectin
vitronectin Type I collagen osteogenin and bone sialoprotein
2 The second approach uses biomolecules with osteotropic
effects which range from mitogenicity (interleukin growth
factor-I FGF-2 platelet derived growth factor ndashBB) to the
increasing activity of the bone cells which enhances the
collagen synthesis for osteoinduction
Zirconia implants
Zirconia (Zr02) is a ceramic material used in implantology because
Biocompatibility(bio inert)
Esthetics (because its colour is similar to the teeth) and
Mechanical properties which are better than alumina
High resistance to corrosion flexion and fracture
Contact with bone and soft tissue similar to that observed in
titanium implants
It can be used to produce a entire implant or as a coating
Advantages of Zirconia Dental Implants
No dark colour of the metal showing through the gums
No corrosion of the zirconia as with titanium
No piezo-electric currents between dissimilar metal in
the mouth
It is thermally non-conductive
Greater BIC (Bone ndash Implant Contact)
20 more bone apposition than titanium implants
Zeynep Ouml zkurt Zirconia Dental Implants A Literature Review Journal of Oral Implantology Vol 37(3)2011
RTQ (removal torque testing) Gahlert et al evaluated the RTQ values of
machined zirconia implants sandblasted zirconia implants and SLA titanium
implants The mean RTQ for machined zirconia implants was 259 Ncm the
mean RTQ for zirconia rough implants was 405 Ncm and the mean RTQ for
SLA titanium implants was 1052 Ncm
Fracture strength within clinically acceptable limits
Stress analysis Kohal et al observed the stress distribution patterns of
zirconia implants (ReImplant) which were found to have low well distributed
and similar stress distribution compared with titanium implants
PEEK implants (poly etheretherketone)
These implants are available in three fundamentally different
designs
TAU Diameter -48 mm lengths 10 125 15 mm
immediate loading possible
Low density bone
THETA Similar to TAU but D1 bone
IOTA It is a 3mm diameter implant (10 and 12 mm)
used in narrow ridges
Advantages
Good strengthfracture resistance and bioinertness
Promotes human oseteoblast cell growth
Disadvantages
Faintly radiopaque ndashdifficult for post-op evaluation
Lengths and diameters range is restricted
Advances in
commercially
available implant
systems
LASER- LOK TECHNOLOGY
Unique surface characteristics
Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using
laser ablation technology
Extremely consistent microchannels that are optimally
sized to attach and organize both osteoblasts and
fibroblasts
Includes a repeating nanostructure that maximizes
surface area and enables cell pseudopodia and collagen
microfibrils to interdigitate with the Laser-Lok surface
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Zirconia implants
Zirconia (Zr02) is a ceramic material used in implantology because
Biocompatibility(bio inert)
Esthetics (because its colour is similar to the teeth) and
Mechanical properties which are better than alumina
High resistance to corrosion flexion and fracture
Contact with bone and soft tissue similar to that observed in
titanium implants
It can be used to produce a entire implant or as a coating
Advantages of Zirconia Dental Implants
No dark colour of the metal showing through the gums
No corrosion of the zirconia as with titanium
No piezo-electric currents between dissimilar metal in
the mouth
It is thermally non-conductive
Greater BIC (Bone ndash Implant Contact)
20 more bone apposition than titanium implants
Zeynep Ouml zkurt Zirconia Dental Implants A Literature Review Journal of Oral Implantology Vol 37(3)2011
RTQ (removal torque testing) Gahlert et al evaluated the RTQ values of
machined zirconia implants sandblasted zirconia implants and SLA titanium
implants The mean RTQ for machined zirconia implants was 259 Ncm the
mean RTQ for zirconia rough implants was 405 Ncm and the mean RTQ for
SLA titanium implants was 1052 Ncm
Fracture strength within clinically acceptable limits
Stress analysis Kohal et al observed the stress distribution patterns of
zirconia implants (ReImplant) which were found to have low well distributed
and similar stress distribution compared with titanium implants
PEEK implants (poly etheretherketone)
These implants are available in three fundamentally different
designs
TAU Diameter -48 mm lengths 10 125 15 mm
immediate loading possible
Low density bone
THETA Similar to TAU but D1 bone
IOTA It is a 3mm diameter implant (10 and 12 mm)
used in narrow ridges
Advantages
Good strengthfracture resistance and bioinertness
Promotes human oseteoblast cell growth
Disadvantages
Faintly radiopaque ndashdifficult for post-op evaluation
Lengths and diameters range is restricted
Advances in
commercially
available implant
systems
LASER- LOK TECHNOLOGY
Unique surface characteristics
Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using
laser ablation technology
Extremely consistent microchannels that are optimally
sized to attach and organize both osteoblasts and
fibroblasts
Includes a repeating nanostructure that maximizes
surface area and enables cell pseudopodia and collagen
microfibrils to interdigitate with the Laser-Lok surface
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Advantages of Zirconia Dental Implants
No dark colour of the metal showing through the gums
No corrosion of the zirconia as with titanium
No piezo-electric currents between dissimilar metal in
the mouth
It is thermally non-conductive
Greater BIC (Bone ndash Implant Contact)
20 more bone apposition than titanium implants
Zeynep Ouml zkurt Zirconia Dental Implants A Literature Review Journal of Oral Implantology Vol 37(3)2011
RTQ (removal torque testing) Gahlert et al evaluated the RTQ values of
machined zirconia implants sandblasted zirconia implants and SLA titanium
implants The mean RTQ for machined zirconia implants was 259 Ncm the
mean RTQ for zirconia rough implants was 405 Ncm and the mean RTQ for
SLA titanium implants was 1052 Ncm
Fracture strength within clinically acceptable limits
Stress analysis Kohal et al observed the stress distribution patterns of
zirconia implants (ReImplant) which were found to have low well distributed
and similar stress distribution compared with titanium implants
PEEK implants (poly etheretherketone)
These implants are available in three fundamentally different
designs
TAU Diameter -48 mm lengths 10 125 15 mm
immediate loading possible
Low density bone
THETA Similar to TAU but D1 bone
IOTA It is a 3mm diameter implant (10 and 12 mm)
used in narrow ridges
Advantages
Good strengthfracture resistance and bioinertness
Promotes human oseteoblast cell growth
Disadvantages
Faintly radiopaque ndashdifficult for post-op evaluation
Lengths and diameters range is restricted
Advances in
commercially
available implant
systems
LASER- LOK TECHNOLOGY
Unique surface characteristics
Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using
laser ablation technology
Extremely consistent microchannels that are optimally
sized to attach and organize both osteoblasts and
fibroblasts
Includes a repeating nanostructure that maximizes
surface area and enables cell pseudopodia and collagen
microfibrils to interdigitate with the Laser-Lok surface
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
RTQ (removal torque testing) Gahlert et al evaluated the RTQ values of
machined zirconia implants sandblasted zirconia implants and SLA titanium
implants The mean RTQ for machined zirconia implants was 259 Ncm the
mean RTQ for zirconia rough implants was 405 Ncm and the mean RTQ for
SLA titanium implants was 1052 Ncm
Fracture strength within clinically acceptable limits
Stress analysis Kohal et al observed the stress distribution patterns of
zirconia implants (ReImplant) which were found to have low well distributed
and similar stress distribution compared with titanium implants
PEEK implants (poly etheretherketone)
These implants are available in three fundamentally different
designs
TAU Diameter -48 mm lengths 10 125 15 mm
immediate loading possible
Low density bone
THETA Similar to TAU but D1 bone
IOTA It is a 3mm diameter implant (10 and 12 mm)
used in narrow ridges
Advantages
Good strengthfracture resistance and bioinertness
Promotes human oseteoblast cell growth
Disadvantages
Faintly radiopaque ndashdifficult for post-op evaluation
Lengths and diameters range is restricted
Advances in
commercially
available implant
systems
LASER- LOK TECHNOLOGY
Unique surface characteristics
Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using
laser ablation technology
Extremely consistent microchannels that are optimally
sized to attach and organize both osteoblasts and
fibroblasts
Includes a repeating nanostructure that maximizes
surface area and enables cell pseudopodia and collagen
microfibrils to interdigitate with the Laser-Lok surface
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
PEEK implants (poly etheretherketone)
These implants are available in three fundamentally different
designs
TAU Diameter -48 mm lengths 10 125 15 mm
immediate loading possible
Low density bone
THETA Similar to TAU but D1 bone
IOTA It is a 3mm diameter implant (10 and 12 mm)
used in narrow ridges
Advantages
Good strengthfracture resistance and bioinertness
Promotes human oseteoblast cell growth
Disadvantages
Faintly radiopaque ndashdifficult for post-op evaluation
Lengths and diameters range is restricted
Advances in
commercially
available implant
systems
LASER- LOK TECHNOLOGY
Unique surface characteristics
Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using
laser ablation technology
Extremely consistent microchannels that are optimally
sized to attach and organize both osteoblasts and
fibroblasts
Includes a repeating nanostructure that maximizes
surface area and enables cell pseudopodia and collagen
microfibrils to interdigitate with the Laser-Lok surface
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Advantages
Good strengthfracture resistance and bioinertness
Promotes human oseteoblast cell growth
Disadvantages
Faintly radiopaque ndashdifficult for post-op evaluation
Lengths and diameters range is restricted
Advances in
commercially
available implant
systems
LASER- LOK TECHNOLOGY
Unique surface characteristics
Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using
laser ablation technology
Extremely consistent microchannels that are optimally
sized to attach and organize both osteoblasts and
fibroblasts
Includes a repeating nanostructure that maximizes
surface area and enables cell pseudopodia and collagen
microfibrils to interdigitate with the Laser-Lok surface
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Advances in
commercially
available implant
systems
LASER- LOK TECHNOLOGY
Unique surface characteristics
Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using
laser ablation technology
Extremely consistent microchannels that are optimally
sized to attach and organize both osteoblasts and
fibroblasts
Includes a repeating nanostructure that maximizes
surface area and enables cell pseudopodia and collagen
microfibrils to interdigitate with the Laser-Lok surface
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
LASER- LOK TECHNOLOGY
Unique surface characteristics
Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using
laser ablation technology
Extremely consistent microchannels that are optimally
sized to attach and organize both osteoblasts and
fibroblasts
Includes a repeating nanostructure that maximizes
surface area and enables cell pseudopodia and collagen
microfibrils to interdigitate with the Laser-Lok surface
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Biologic response
The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers)
This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health
More effective than other implant designs in reducing bone loss
The Laser-Lok surface has been shown in several studies to offer a
clinical advantage over other implant designs to reduce bone loss
by 70
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
NobelReplacetrade Tapered Groovy implant
NobelReplacetrade Tapered Groovy implant is shaped to resemble a
tooth root
New and unique grooved threads
Since bone forms more rapidly in the grooves the Groovy
implants integrate faster
Tapered design makes surgical procedure exceptionally simple
and predictable ndash especially for immediate placement after
extraction
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Indications
For immediate placement after extraction
Whenever immediate or early loading is applied
Advantages of groove pattern
Faster integration with grooves
Bone formed preferentially within the grooves compared to
other parts of the implant
Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
Up to 30 increase in stability
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
The NobelSpeedytrade implant
Features
Parallel walled implant
Slightly tapered design
TiUnitereg surface provides accelerated osseointegration over
machined surface implants
Narrow tip makes it perfect for flapless surgery
Primary stability at time of implant placement
Shortening treatment time and speeding recovery
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
The innovative implant tip is sharp so the implant works as an
osteotome
This feature allows variable and if needed extensive under-
preparation of the site
The resulting higher initial stability especially in soft bone
supports immediate function
The sharp tip also secures a smooth insertion
It provides the possibility to increase torque and place the
implant further down without repeating the drilling procedure
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
NobelSpeedytrade Replace
Narrow Tip Sharper Chamfers
Internal Abutment Connection
Slightly Tapered
TiUnitereg all the way up
Extremely Short Drill Protocol
Grooves on threads
Increased initial stability in soft bone
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
NobelSpeedytrade Groovy
Same benefits as NobelSpeedytrade Replace
In addition
External Abutment Connection
Including Shorty implant
NobelSpeedytrade Shorty (7mm)
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
NobelActivetrade Implant
NobelActivetrade implants do not cut through bone like
conventional implants they gently press through it like a corkscrew
This bone condensing capability delivers high initial stability
The narrow neck is designed to preserve marginal bone and
promote long-lasting soft tissue stability
The self-drilling ability of NobelActivetrade implants allows it to be
inserted into sites prepared to a reduced depth
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
This is useful where sites are close to vital anatomical
structures the mandibular nerve canal or the maxillary
sinus and nose cavity
Immediate placement in the esthetic region even when
buccal bone plate is very thin
Excellent stabilization in wide sockets
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
NobelPerfecttrade
NobelPerfecttrade is a unique anatomically designed implant for
esthetically demanding areas from premolar to premolar
The interproximal bone may be preserved in situations where the
three-dimensional ridge topography results in a height discrepancy
between the facial and interproximal aspect of the osteotomy
Scalloped soft tissue apposition area allows for the development
of the biologic width around the entire neck of the implant
Scalloped prosthetic table follows three-dimensional soft tissue
topography
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
The NobelPerfecttrade One-Piece implant
The NobelPerfecttrade One-Piece implant is machined from a single
piece of titanium
The scalloped TiUnite surface contour at the implant neck follows
the same principles as for the original NobelPerfecttrade
With this design the soft tissue is supported entirely by the
implant body irrespective of the shape of the osseous ridge
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
NobelDirect Implant
The NobelDirect Groovy implant features a revolutionary new one-
piece design that is
User-friendly
Cost-effective
Biologically sound and
Esthetically stable
The implant is machined from a single piece of titanium
incorporating both the implant body and an integral fixed
abutment
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Astra Tech implant system
OsseoSpeedtrade -chemically modified titanium surface
Providing unique nano scale topography
Stimulates early bone healing and speeds up the bone healing
process
The result of the micro-roughened titanium surface treated with
fluoride is increased bone formation and stronger bone-to-implant
bonding
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
MicroThreadtrade
The neck of Astra Tech implants are designed with MicroThread
that has minute threads that offer optimal load distribution and
lower stress values
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Conical Seal Designtrade a strong and stable fit
Conical connection below the marginal bone level transfers the
load deeper down in the bonehelliphellip
Reduces peak stresses and thereby preserves the marginal bone
Seals off the interior of the implant from surrounding tissues
minimizing micro-movements and micro-leakage
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Straumann SLActive implant
Chemical modification to a sandblasted large-grit acid-
etched (SLA) implant surface
Hyrdophilicity
Protein adsorption
Enhanced osteoblast activity within the first weeks
Enhanced angiogenesis and bone healing within the first
few days after contact with the new surface
This surface reduced the average healing time from 12
weeks (TPS surface) to only 6-8 weeks
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Straumann Roxolid Implant
Roxolidreg is a homogenous metallic alloy composed of the
elements titanium and zirconium
Higher tensile strength compared to pure titanium
Important when small diameter implants are chosen due to their
reduced size
Roxolidreg and SLActivereg combine high strength with excellent
osseointegration
Roxolidreg implants have been used where 33mm titanium
implants previously were not suitable
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Software Simplifying
Treatment Planning
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
SimPlant software
Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography
The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant positioning
These successive diameter surgical osteotomy drill guides may be
either bone teeth or mucosa-borne
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Surgi Guides have metal cylindrical tubes that correspond to the
number of desired osteotomy preparations and specific drill
diameters
The diameter of the drilling tube is usually 02mm larger than the
corresponding drill thus making angle deviation highly unlikely
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
NobelGuide
NobelGuide is a complete treatment concept for
Diagnostics
Prosthetic-driven treatment planning and
Guided implant surgery ndash for a single missing tooth to an
edentulous jaw
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
NobelClinician Software
NobelClinician Software is the next generation software for
Digital diagnostics and Treatment planning
Through various pre-defined workspaces any DICOM file can be
reviewed and analyzed
It combines a patients detailed clinical information with 3D
radiographic data into a sophisticated virtual environment
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
CADCAM in implant dentistry
Uses Used in designing of prosthesis
Used in milling fabrication of prosthesis(framework)
For milling of abutments
AdvantagesSuperior fit
Less degree of rotational freedom so more accurate implant
abutment connection
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
CADCAM
system
Provider Implant restoration type
Restorationmaterial
Procera Nobel Biocare
AbutmentsFixed partial
denture frameworksMilled bars
TitaniumAluminaZirconia
Atlantis Astra Tech
Abutments TitaniumTitanium with gold
coatingZirconia
Encode Biomet 3i Abutments TitaniumTitanium with gold
coating
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
CAM StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments TitaniumZirconia
Etkon Straumann FrameworksAbutments
ZirconiaTitanium
BioCad BioCadMedical
AbutmentsMilled bars
Titanium
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Recent advances in
Implant Abutments
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Angled abutments
Used to improve the path of insertion of prosthesis or final
esthetic result
Fabricated in 2 pieces - so weaker in design
Implant placed at an angle requires angled abutment
Inclination range from 10-350
Has 12 facets amp 12 positions of angulation in a 3600 circle
Has non rotating interface with implant
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
UCLA ABUTMENT
Designed by JohnBeumer Wynn Hornburg and Peter E Staubli
It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues
It is a plastic castable sleeve
Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant
This abutment is available for all implant systems
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Advantages
Subgingival placement of the restoration
Helps with interocclusal distance limitations
Improved esthetics
More apical position only allows the emergence profile through
the soft tissue and natural in appearance
Can be in porcelain instead of the usual titanium
cylinder
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Ceramic abutments
Densely sintered high-purity alumina (al2o3) ceramic
Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal
ceramics
Alumina abutments
Flexural strength of 400 mpa
A fracture toughness value between 5 and 6 mpa frasl m05
Modulus of elasticity of 350 GPa
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Advantages
Easier to prepare intraorally
Less whitish than zirconia abutments
The problems
Radioopalescence at the time of radiographic examination
Weak resistance to fracture
Zirconia abutments
Twice the flexural strength of alumina ceramic -900ndash1400 mpa
A fracture toughness of up to 10 mpa frasl m05
Modulus of elasticity value -210 gpa
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Advantages
Perfect aesthetics and stability
Outstanding anatomical design
Dual concept titanium base ZrO2 abutment
Highest precision of fit
Indications
Fixed restorations single crowns and bridgework
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
CERADAPT ABUTMENTAll ceramic alternative to metal abutments
Pre machined precision milled abutment made to fit the implant
hex - made up of densely sintered 998 pure aluminium oxide
It is a non metallic non corrosive bio compatible
Soft tissue response is excellent
Tooth coloured and light diffusion property
Used for implant supported single and multiple tooth restoration
in the anterior canine and premolar regions
The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in
diameter
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Indications
1 An implant placed too superficiallyresulting in exposed Ti at
the buccal aspect
2 An implant with excessively buccal placement amp thin peri-
implant mucosa -shining-through effect of the Ti abutment
3 A slight disangulation of the implant resulting in a need to
correct the direction of the implant pillar to create a
harmonious embrasure amp anatomy of the crown restoration
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Multi-Unit abutment
Serve as a one-piece abutment
Available in 7 lengths for each platform from a 1-to 9-mm collar
Total height of multi-unit abutment including the gold cylinder
amp the unigrip prosthetic screw is 505 mm
Allows for a disangulation of as much as 40 degrees between the
long axis of the implants
In situations with greater disangulation the angulated abutment
is used
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Implant ndashAbutment
Interface
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
External Hex Internal Hex Morse Taper
bullExternal hex-07mm standard
hexagon
bullInterchangeable in regular
size platform
bullScrew loosening
bullMechanical failure
bullRotational misfit
bull17-mm-deep hex below a 05-
mmndash wide 45deg bevel
bullDistribute intraoral forces deeper
within the implant to protect the
retention screw from excess
loading
bullReduce the potential of
microleakage
bullSuperior strength
bullTapered
abutment post is
inserted into the
nonthreaded shaft
of a dental
implant with the
same taper
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Osseotite Certain 3i Implant Innovations
The internal connection implant design incorporates an audible
and tactile ldquoclickrdquo when the components are properly seated
Reduces the need for radiographs
This internal connection design incorporates a 6-point hex
and a 12-point double-hex internal design
The 6-point internal hex -straight abutments
The 12-point double-hex -machined preangled abutments to
correct the off-axis emergence of the implant
Israel M Finger et al The evolution of external and internal implantabutment connections Pract Proced
Aesthet Dent 200315(8)625-632
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Platform switching
The platform switching concept is based on the use of an
abutment smaller than the implant neck
This type of connection moves the perimeter of IAJ to the center
of implant axis
It is likely that moving the IAJ inward brings out bacteria more
internally and therefore away from the bone crest this would
explain the limitation in bone resorption
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Atieh et al (2010) conducted a systematic review on the clinical
relevance of platform switching and preservation of peri-implant
crest bone levels Ten clinical studies reported a statistically
significant influence of the platform switching on the maintenance
of marginal bone levels
Annibali et al (2012) conducted a similar systematic review en
randomized controlled trials were selected for review dated from
2007 to 2011 Six of the ten clinical studies noted a significant
difference of reduced marginal bone loss around platform
switching implant-abutment group versus a traditional design
Joseacute Paulo Macedo et al Morse taper dental implants and platform switching The new paradigm in oral
implantology Eur J Dent 2016 JanMar 10(1) 148ndash154
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
New concepts in
Implants
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
All on Four
Four implants in edentulous jaws two straight two tilted
providing a secure and optimal support for a prosthetic fixed
bridge (even with minimum bone volume)
Maximizes the use of available bone by tilting the posterior
implants by up to a maximum of 45ordm
Benefits of Angled posterior implants bull Help avoid relevant anatomical structures and can be anchored in better quality anterior bonebull Offer improved support of the prosthesis by reducing cantileversbull Reduce the need for bone grafting by maximizing the use of available bone
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Final restoration
bull Full-arch restoration with only 4 implants
bull Fixed and removable final prosthetic solutions
bull Flexible solutions
Efficient Treatment Flow
bull Immediately loaded for shorter treatment times and improved patient satisfaction
Implant Placement Accuracy
bull All-on-4 Guide assists with accurate placement of implants
bull Can be combined with computer-aided diagnostics and treatment concept NobelGuide
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Zygoma Implants
Branemark developed a specific implant called the zygomaticus
fixture to provide fixed solutions even when the conditions for
implant insertion were poor in the posterior maxilla
zygomatic implants as self-tapping screws in commercially pure
titanium with a well-defined machined surface
8 different lengths ranging from 30 to 525 mm
45 angulated head to compensate for the angulation between the
zygoma and the maxilla
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
The portion that engages the zygoma the apical two thirds has a
diameter of 40 mm and the portion that engages the residual
maxillary alveolar process alveolar one third has a diameter of 45
mm to 5 mm
Provide immediate or early loading with immediate function
Less morbidity
Indications
Severe resorption of maxilla
Free-end situations in maxilla with insufficient bone height
Total edentulism together with reduced bone height
Pneumatization of maxillary sinus
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
The most common complication was maxillary sinusitis
Other less frequent complications ndash
Minor sinus membrane perforation
Gingival infections
Fistula
Lip laceration
Paresthesia
Implant
Fractures of prosthesis
The weighted average success is 9705 and maxillary
sinusitis was the most common complication ranging from
15 to 1842
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Conclusion
bullWith the advancements in bioengineering and biomaterials fields
continued effort of dedicated dental faculties several innovation have made
implant dental treatment a highly successful option for patient
bullThe incorporation of new tech and by methods has improved the specific
areas of conventional treatment procedures
bullContinued research will determine if specific implant modification will
diminish complication and improve implant serviceability additionally
future deviation in material and tech will surely improve their efficacy
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
References
Carl e misch contemporary implant dentistry 3 rd edition
Israel m Fingerthe evolution of external and internal implantabutment
connections pract proced aesthet dent 200315(8)625-632
Eugenia candel-martı rehabilitation of atrophic posterior maxilla with
zygomatic implants review journal of oral implantology vol Xxxviiino Five2012
Suraksha shrestha current concepts in biomaterials in dental implant science
research Vol 2 no 1 2014 pp 7-12
Hemlata garg et al implant surface modification a review journal of clinical
and diagnostic research 2012 april vol-6(2) 319-324
SAnil et al dental implant surface enhancement and osseointegration implant
dentistry a rapidly evolving practice
William c Scarfe clinical applications of cone-beam computed
Tomography in dental practice jcda february 2006 vol 72 no 1
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
David gelb clinical and radiographic evaluation of braringnemark
implants with an anodized surface following seventoeight years of
functional loading int j dent 2013 2013 583567
Dental implant surface treatments using laserlok microchannels |
biohorizons
Aishwarya nagarajan et al diagnostic imaging for dental implant
therapy clin imaging sci 2014 4(suppl 2) 4
Jack a Hahn clinical and radiographic evaluation of one-piece
implants used for immediate function journal of oral implantology
vol Xxxiiino Three2007
Ralf-j Kohal ceramic abutments and ceramic
Oral implants An update periodontology 2000 vol 47 2008 224ndash
243
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Reham b Osman a critical review of dental implant materials with
an emphasis on titanium versus zirconia materials 2015 8 932-958
Puneet chopra mini dental implants-the same day implantsijcd
june 2011 (3)
Joseacute paulo macedo et al morse taper dental implants and platform
switching the new paradigm in oral implantology eur j dent 2016
janmar 10(1) 148ndash154
Mohit g kheur transitional implants an asset to implantologyj
interdiscip dentistry year 2011 | volume 1 | issue 1 | page 49
Zeynep ouml zkurt zirconia dental implants a literature review journal
of oral implantology vol Xxxviino Three2011
Ashu sharma zygomatic implantsfixture a systematic review journal
of oral implantology vol Xxxixno Two2013
Thank you
Thank you
