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DENTAL IMPLANTS( Dr MAHESH RAJ V)
- 2. Dental implants Department ofperiodontics Dr.Mahesh Raj V.V.
- 3. Definition Dental implantis a biologic or alloplastic biomaterial, which is surgically inserted into the soft or hard tissues of the mouth for functions or cosmetic reasons An alloplastic and biocompatible material placed in to or on to the jawbone to support a fixed prosthesis or to stabilize removable prosthesis
- 4. Fudamental science Osseointegration– (Branemark 1986)- direct structural and functional connection between ordered living bone and the surface of a load carrying implant SG Steinemann – defined it as direct contact between bone and implant surface
- 5. Osseointegration (phases) Bloodclot formation at implant-bone interface Infiltration of neutrophils and macrophages(3-5days) Local hypoxia Release of cytokines Neovascularisation Cellular differentiation Matrix synthesis Osteogenesis Woven bone formation Lamellar bone formation
- 6. Successful osseointegration Absenceof mobility clinically Asymptomatic Stable crestal bone level Increased mineralization Healthy soft tissue Absence of Peri-implant radiolucency RoughenedTi Implant surface is better than conventionally machinedTi surface
- 7. Contact and Distantosteogenesis Contact osteogenesis New bone synthesis begins at the implant surface Distant osteogenesis New bone synthesis begins at the osteotomy wall
- 8. OsseointegrationVs Osseocoalescence Osseointegration-refers to physical integration or mechanical fixation of an implant in the bone Osseocoalescence/ Biointegration- refers to the chemical integration of bone to the surface enhanced active materials (HA,BG) on the implant surface Osseointegration- provides good resistance to shear forces but poor resistance to tension Osseocoalescence- provides good resistance to both shear and tensile forces
- 9. Primary stability-mechanical stability achieved during implant insertion Secondary stability- stability achieved by means of Osseointegration (4-6months) Soft tissue integration- Biological processes that occur during the formation and maturation of the structural relationship between the soft tissue and the transmucosal implant superstructure
- 10. Anatomic features ImplantVs Naturaltooth Features Periodontal tissue Peri- implant tissue Periodontal ligament Present Not present Sulcular epithelium Present Present Junctional epithelium Present Present Basal lamina Present Present Hemidesmosomes Present Present Glycoprotien adhesion Present Present CT attachment Present Absent Soft tissue circulation Three sources (PL, Bone, periosteum) Two sources (Basal bone, periosteum) Surrounding CT Vascular and cellular Hypovascular and
- 11. classification A –Endosteal/Endosseous B - Subperiosteal C –Transosteal/Transosseous Basal osseointegrated implants (BOI)
- 12. Endosteal implants Adevice placed in to the alveolar and or basal bone of the mandible or maxilla, transects only one cortical bone
- 13. Endosteal implants(forms) 1-Rootform/ cylindrical 2- Bladeform ( a thin elongated , flat device designed to be secure in narrow or even knife edged alveolar bone) Eg: Ramus frame Implant
- 14. Subperiosteal Implant Itemploys an implant substructure & superstructure, which rests on the alveolar bone beneath the gingiva Placed under the periosteum and fixed over the jaw bone (severely resorbed mandible)
- 15. Tranosteal/Transosseous Implants Itcombines with both subperiosteal and endosteal components which penetrates both cortical plates and passes trough full thickness of alveolar bone (restricted to anterior mandible)
- 17. Basal osseointegrated implants Indicated for cases with limited bone volume, bone height above mandibular canal, sinus pneumatization Needs lateral approach (lateral bone cutter to prepare lateral slot) Engages basal bone or disc bicortically
- 18. Implant Macrodesign (3 types) 1 – cylinder root form 2 – screw root form 3 - combination
- 19. Cylinder root forms Offers the advantage of ease of placement in difficult access location( type IV bone) Are either smooth sided or bullet shaped , requires a bioactive surface for better integration
- 20. Screw root forms Common Square V shaped Buttress threads Variations Straight Tapered Conical Ovoid Expanding body
- 21. Combination Posses macroscopic featuresof both cylinder and screw root forms
- 22. Classification (Root formimplants) A- Based on surface design - Non threaded implants Offers the advantage of more surface area and more bone implant – surface contact eg: endopore – Threaded implants B – Based on body design - Parallel body - Tapered
- 23. C- Basedon implant connection External connection (external hex) Implant connection emerges above the implant platform and act as the male part where all implant components gets engaged Internal connection (internal hex) Implant connection remain inside the implant body and act as female part
- 24. D –based on connection design Triangular design – 3 faces Hexagonal design – six faces Octagonal design – eight faces
- 25. Smooth surface /non-hex (cold-weld )design Doesn’t have any faces, but a smooth surface tube in tube connection Abutment gets cold welded in to the implant connection Prevents microbial growth
- 26. Morse taperconnection Combination of both hexed and non hexed (coldwelded, Tube in Tube) connection Has a hex in the deepest half of internal connection as anti rotational features Its smooth non hexed surface in crestal half makes a tight seal to prevent bacterial growth
- 27. E- Basedon materials used Titanium and its alloy implants Zirconium implants F- Based on thread design Square / u shaped- Non – cutting thread V shaped – cutting/self tapping thread
- 28. G- Basedon crestal polish collar Subgingival (two stage implants) Trans gingival (one stage ) implant H- Based on implant pieces Two - piece implant One – piece implant
- 29.
- 30. Implant Abutment Interface Implant is connected to the abutment by coupling which is external about 2mm superior and internally about 5 mm inferior to the coronal surface of implant External connection is either a standard hexagonal or octagonal with 0.7mm platform
- 31. Continuation............. Internal connection (slipfit/frictionalfit) Slip fit – passive fit of abutment part of implant like octagonal, hexagonal, cone screw with a non rotational feature Preferred- Deep internal hexagon
- 33. Implant Biomaterials A- Metals Stainless steel Cobalt-chromium-molybdenum based Titanium and its alloys (Ti-Al-Va) B- Ceramics Hydroxyapatite Bioglass Aluminium oxide Polymers and composites Others, gold, carbon etc
- 34. Micro design- surfacecoating Anodization – prevent corrosion of pure titanium by oxidization (TiO2) Hydroxyapatite coating- Better osseointegration Gap healing can be enhanced by HA coating Less metal corossion High success rate in D4 bone Plasma nitriding or spraying- done by spraying molten metal inTi base - (Increases tribiological properties(Biocompatibility, Bio adhesion, Biofunctionality) Polyethylene grafted polycationic polymers – gets bond to negatively changed TiO2 which helps surface proteins to bond with surface modified titanium Alkaline treatment- create a porous, hydrated and reactive titanium oxide surface
- 35. Laser treatment-melt surface layer locally to embed a new phase in a substrate (CO2, Nd-YAG laser) Sand blasted ( using Al2O3 ,TiO2 & CaPo4)and Acid etched surface( using HCL,H2So4)- increase surface roughness by producing macro/ micro texture , increases BIC-(bone implant contact) percentage
- 36. Implant components A-Fixtureor implant body B- Implant abutment or Transmucosal abutment Implant mount Cover screw Gingival former/healing abutment/permucosal extension Impression post/impression transfer abutment Implant analogue Abutment screw C- Actual prosthesis (Screwed joints/ cemented joints)
- 37. Implant components 1- Implantfixture/Implant body Implant itself which gets osseointegrated with the bone 2- Implant mount Used to carry implantfrom its vial 3- cover screw Used to cover the implant connection during submerged healing 4- Gingival former/healing screw/ abutment/ permucosalextension Used to form a healthy , aesthetic emergence profile 5- Impression post Used to transfer the implant hex position and orientation from mouth to working cast 6- Implant analogue Has a different body with similarplatform and connection of implant 7- Transmucosal abutment Serves as an attachmentbetween implantand actual prosthesis
- 38. Implant components IMPLANT FIXTUREIMPLANT MOUNT
- 39. COVER SCREW GINGIVALFORMER
- 40. Impression post Implant analogue
- 41. Types of impressionpost CLOSEDTRAY IMPRESSION POST OPENTRAY IMPRESSION POST
- 42. Open tray impressionpost It posses deep retention grooves along its body and long connection screw A part of its long screw emerges out of the impression tray and should be unscrewed before removing the impression from implant so that the post comes out embedded in the impression The impression is then poured in die stone
- 43.
- 44. Closed tray impressionpost It posses shallow retention grooves along its body and short connection screw The complete post remains under the impression and no part of it emerges out of the tray After making impression this post is removed from implant , assembled to analogue and inserted to the impression with the same orientation The impression is first poured with soft tissue replicating material followed by dental stone
- 45. Closed tray impressiontechnique
- 46. Abutment (classification) 1Abutment for ball retained over dentures
- 47. 2 Abutmentfor cement – retained fixed prosthesis a- Straight abutment b- Angled abutment ( 5,15,25,30) c- Anatomical / Aesthetic abutment d- Zirconium abutment e-Temporary abutment
- 48. 3-Plastic orcastable abutment
- 49. 4- abutmentfor abutment level screw retained fixed prosthesis
- 50. 5-Engaging abutment Hastriangular or octagonal hex connection so can be fixed only to implant at particular oriental position Non engaging abutment Do not have any connection so can be fixed at any orientation
- 51. 6-UCLA abutment- castable abutment 7-Multi unit abutment (17 and 30 degree angulations) Used in all on 4 and all on 6 technique
- 52. Platform switching orcommon platform concept Are implant with similar platform so that any of the components could be fitted to any implant in a particular system irrespective of diameter When smaller diameter abutment is used over the regular or wider implant , it forms an implant – abutment junction narrower than diameter of implant , apical to and diameter of abutment occlusal to this junction Such junction provided stress free space for formation of thick bone and soft tissue in crestal region Platform switching may reduce crestal bone resorption by about 70%
- 53. Inventories for basicimplant procedures Dental implant surgical kit Implant motor (physiodispensor) Rotary reduction hand piece Basic oral surgery instruments
- 54. 1- Dental implantsurgical kit Large round carbide bur Small round carbide bur Pilot drill Width- increasing/widening drills Parallel guide/depth guide Parallel and spacing guide Drill stoppers Bone tap or thread former Crestal bone drill/ counter sink drill Drill extender Implant depth probe Implant driver- rotary hand piece/ hand ratchet driven Ratchet – wrench/ torque ratchet Screw driver / hex driver
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- 56.
- 57. Drilling sequence fordifferent diameter implants
- 58. Paralleling pins &depth guide PARALLELING PINS DEPTH GUIDE
- 59. Drill stopper/ implantdepth probe DRILL STOPPER IMPLANT DEPTH PROBE
- 60. BONE TAP/ THREADFORMER (20-40 RPM) CRESTAL BONE / COUNTER SINK DRILL (1500-2000 RPM)
- 61.
- 62. Implant driver HAND RATCHETDRIVEN HAND PIECE DRIVEN
- 63.
- 64. Screw driver/ Hexdriver
- 65. Physiodispensor Torque control(0-50Ncm) Speed control Implant insertion- (20rpm) Hard bone drilling(2500rpm) 20:1 speed reduction hand piece 1:1 hand piece- (osteoplasty,bone harvesting, sinus window preparation)
- 66. Rotary hand piece 1:1 straight/ contra angle 20:1 speed reduction Hand piece New generation fibre optic hand piece
- 67.