Dental Implantation and Bone Remodeling

Dental implantation involves using inert foreign body implants in human tissues.
Implants benefit patients psychologically and improve masticatory efficiency.
A dental implant is a non-viable, biocompatible device placed in the jawbone to support a prosthesis or tooth.
Implants are susceptible to problems similar to natural teeth, except for caries.
The same care is needed for oral cavity preparation prior to implant placement as before any other rehabilitative procedure.

Modeling refers to changes in bone morphology during growth, a turnover and replacement process in all bones.
Ridge resorption and atrophy are not a separate process; resorption is part of the turnover process in all bones.
Bone remodeling involves three steps:
- Activation: triggered by localized and systemic stimuli (e.g., stress and hormones).
- Resorption: osteoclasts mediate the resorption process in bone envelopes such as periosteum, haversian, and endosteal (trabecular). The process often mirrors the stress applied.
- Formation: osteoblasts synthesize organic matrix, then mineralizes after 14 days. Resorption and regeneration often occur concurrently.

Metabolic bone disease encompasses any process affecting normal bone modeling; osteopenia defines a clinical term signifying bone density loss.
Osteoporosis: Characterized by a reduction in bone mass per unit volume, often leading to mechanical failure. Common in senile, postmenopausal conditions, hyperparathyroidism, and Cushing disease.
Osteomalacia: A condition where deficient osteoid mineralization causes impaired bone healing; often associated with vitamin D deficiency, malnutrition and various medical conditions like renal osteodystrophy and chronic corticosteroid therapy.

Facial morphology: Individuals with longer faces typically have more prominent anterior alveolar ridges compared to those with shorter faces.

Disuse atrophy: A low-turnover type of bone remodeling influenced by a lack of use.
Excessive loading: Results in increased remodeling, as seen in individuals with dentures; maxilla is affected more than mandible.
Parafunctional activity: Activities like clenching and bruxism produce continuous high-force contact, impacting bone remodeling, even though they occupy a shorter duration compared to normal chewing.

Babbush's 1985 classification categorizes dental implants by their site:
- Mucosal Inserts, now largely obsolete. This is the result of complex, difficult insertion and complications following the procedure.
- Subperiosteal Implants, a framework that rests on the bone beneath the periosteum, with the superstructure penetrating the mucosa.
- Transmandibular Staple Bone Implants, acting as stabilizers and fasteners for dentures, primarily used for mandibular rehabilitation.
- Endosseous (osseointegrated) Implants, which are surgically inserted into the jawbone; this leads to direct bone growth and osseointegration on the implant surface, which then improves the implant's stability and longevity.

Small mucoperiosteal incision: facilitates easier access
Placement near natural teeth: minimizes risk to adjacent structures.
Immediate or delayed restoration: implants’ removal is possible if needed earlier.
Support for craniofacial prosthetics and potentially orthodontic solutions: supports certain corrective applications.

Ankylosis : Direct bonding of bone to the implant.
Fibrous encapsulation : Formation of a fibrous tissue capsule around the implant.

Site preparation : Avoiding overheating during implant placement prevents osteonecrosis and ensures suitable bone regeneration.
Implant material: Material choice significantly affects the host tissue response; Bio-tolerance, bio-inertness, and bioactivity are possible mechanisms of tissue-implant interaction.

Direct bone-to-implant connection, a desirable condition essential for implant stability and function. This process depends on several factors.

Panoramic Projections: Visualization of vertical height and mental foramen location of the mandible.
Cephalometric Projections: Evaluate cross-sectional dimensions of mandible.
Periapical Projections: Assessment of anatomical areas and bone quality.
Occlusal Projections: Visualization of bone quality and the entire craniofacial structure.
Tomographic Projections: Single plane visualization of tissues; blurring is a disadvantage.
Computed Tomography (CT): Provides high-contrast images, no overlapping. A necessary tool for optimal visualization before surgery.
Cone Beam Computed Tomography (CBCT): A lower-radiation digital modality with exceptional imaging quality.

Describes several treatment protocol types for implant procedures that focus on time and conditions.
Immediate Placement: The implant is placed at the same time as tooth extraction.
Delayed/Delayed placement is where the implant is placed once bone has fully replaced lost teeth.
Semi-immediate Placement: Implant placement after some soft tissue regeneration with the goal of reducing soft tissue trauma for the final placement.

A list of criteria that may indicate optimal success for implant treatments. Success rates vary based on the treatment and specific circumstances and the different scale groups.

List factors contributing to early implant failure. These failure causes vary depending on the stage of treatment or the patient's specific situation.

Lists possible scales and criteria to evaluate implant conditions and quality. Implant failure can range from mild and temporary to more severe and permanent conditions.