Implants and Transplants

• Implantation involves transferring non-living tissues or materials into a biological system.
• Transplantation involves transferring living tissue into a biological system.

Material Classification for Transplants and Implants

• Autologous transplants use tissue from the same organism.
• Bone and teeth transplants are examples of autologous materials.
• Homologous transplants use tissue from another individual of the same species like banked bone harvested from a recently deceased person.
• Heterologous transplants use tissue from another species like bovine bone or corals.
• Alloplastic transplants use foreign substances like metals such as titanium, ceramics, or plastics and are completely synthetic materials
• Alloplastic materials are used in implants.

Dental Implantology

• Anchoring alloplastic materials into the jaws provides support and retention for prosthetic tooth replacement.

History of Dental Implants

• The oldest recorded history of dental implants dates back to the Spaniard Alabucasim in 1100 AD and involved transplanting teeth.
• These teeth were usually removed from young people.
• High failure rates and disease transmission led to increased criticism, including concerns about tuberculosis and syphilis.
• In the 18th and 19th centuries, the development of natural sciences led to the implantation of materials into jaws.
• In the late 19th century, alloplastic materials were shaped to resemble a tooth.
• Hartman in 1891 expanded the indication for implants from aesthetic to functional purposes involving affixing dentures to implanted alloplastic tooth roots using screws.
• Root-form implants involve carving a wood.
• Root-form implants failed due to rot iron infection.
• Stock in 1939 attempted to alter the shape of a dental implant to resemble a tooth root.
• Stock used a chromium-cobalt-molybdenum alloy (vitallium) to create a dental implant with a threaded body resembling a wood screw.
• In 1947, Formigini adapted Stock's idea to create dental implants that did not resemble tooth roots.
• Scialom in 1962 in France recommended a needle implant inserted into the jaw bone in a row.
• Linkow in 1962 introduced implants in the shape of special blades and is considered the father of implantology due to the design and material used in implants and revolutionized implantology and first utilized titanium for implants.

Implant Designs

• Subperiosteal implants are placed onto the bone.
• Endosteal implants are placed into the bone.
• Transosseous implants.
• Zygomatic implants.
• Subperiosteal implants are placed underneath the periosteum and are often used to cover a large surface area, such as a completely edentulous mandible.
• Linkow is the inventor of subperiosteal implants.
• Subperiosteal implants are similar to a saddle.
• Endosteal implants are placed directly into the jaw bone.
• Root Form endosteal implants are conical and mimic the basic shape of the root.
• Root Form endosteal implants designs: Press-fit (cylinder) and Screws (threaded).
• Screws are the majority of implants used.
• Root Form endosteal implants may replace one or more teeth.
• Blade Form implants may be used in any area of the mouth and are wide, flat, and come in various heights and lengths.
• Blade Form implants are popular for narrow bone that has sufficient height.
• Transosseous implants go through and through to the bone.
• Transosseous implants are surgically inserted into the bone.
• Transosseous implants can only be used on the mandible.
• Zygomatic implants are the least common dental implants available and are the most complicated procedure
• Zygomatic implants are placed in the zygomatic bone.

Osseointegration

• Osseointegration is defined as a direct structural and functional connection between ordered, living bone and the surface of a load-carrying implant.
• Per-Ingvar Branemark discovered osseointegration in 1950.
• Bone has the ability to integrate around a titanium surface.
• In 1965, Branemark created an implant.
• Gosta Larsson was the first patient in the world to receive new teeth with titanium implants.
• In 1978, allowed of placements of implant for clinical purposes
• Nobelpharma was founded in 1981 and introduces the development of practical education and training

Biology of Osseointegration

• Bone-implant contact.
• Hematoma (bone to heal).
• Damaged bone.
• Original bone.
• Implant fixture.
• Hematoma transforms into new bone through callus formation.
• Bone undergoes revascularization, demineralization, and remineralization.
• New vital bone remodels in response to masticatory load.
• Fibrous sim nonmineralized connective tissue (if magfail yung implant).
• Bone does not have nerve endings.
• Histological section of an implant shows bone growing in intimate contact with the surface.
• 1900 rpm can generate enough heat to dissolve a bone.
• Osseointegration is defined as a direct bone anchorage to an implant body, providing a foundation to support a prosthesis and transmit occlusal forces directly to bone.
• The rate of osseointegration is affected by: Smooth surface implant system.
• With a smooth surface implant system like polished surface titanium 6-8 months are needed to integrate.
• Rough surface implant system.
• With a rough surface implant system like sand blasted, acid-etched, plasma-sprayed, SLA, SLActive 3-8 weeks are needed to integrate.
• Osseointegration is a living process.
• Fixtures are inserted under controlled conditions without load-related relative motion and are usually allowed to integrate during a 1-3 months healing period.
• Once Osseointegrated, the fixtures are connected to the prosthetic replacement, and forces are transmitted via fixtures to the surrounding bone.
• Bone responds by initiating a continuous process during which it remodels itself to a state of balance around the implants.

Osseoperception

• Osseoperception is particularly valuable when bone anchored prosthetic replacements communicate with the mind to enable restored function.

Biological Width

• Biological Width: a soft tissue band composed of 1mm junctional epithelium and 1mm connective tissue.
• It is situated at the base of the sulcus up to the crest of the alveolar ridge.
• In implantology, biological width does not exist anymore.

Implant Indications

• Single missing tooth.
• Partial edentulism.
• Complete denture.

Alveolar Process

• Forms in harmony with the development and eruption of the teeth and it gradually regresses when the teeth are lost.
• Alveolar process formation and preservation depends on the continued presence of teeth.
• Morphologic characteristics of the alveolar process relate to the size and shape of the teeth, events occurring during eruption, and the inclination of the erupted teeth.
• The tooth and its surrounding attachment tissues the root cementum, the periodontal ligament and the bundle bone establish a functional unit.
• Bundle bone measures 0.5mm.
• Forces from mastication are transmitted from the crown of the tooth via the root and the attachment tissue to the load-carrying hard tissue structures in the alveolar process.
• Tooth loss and changes in function result in a series of adaptive alterations of the now edentulous portion of the ridge.
• The size of the alveolar ridge will become markedly reduced, not only in the horizontal but also in the vertical dimension.

Topography of the Alveolar Process

• Consists of outer walls buccal and lingual/palatal cortical plates and a central portion of spongy bone.
• The central portion of spongy bone is also called trabecular bone (radiographic term) or cancellous bone (histologic term) that contains bone trabecular as well as marrow
• Cortical plate is made up of lamellar bone.
• Lamellar bone contains both concentric and interstitial lamellae.
• Spongy bone contains trabeculae of lamellar bone.
• In adults, spongy bones are surrounded by a marrow that is rich in adipocytes and pluripotent mesenchymal storm cells.
• The trabeculae of the spongy bone are oriented in directions that allow them to take up and distribute stress that occurs during mastication and other tooth contacts.
• The processes of modeling and remodeling that occur following tooth extraction result in pronounced resorption of the various components of the alveolar ridge.
• The buccal bone wall is more pronounced than the resorption of the lingual/palatal wall - hence the center of the ridge moves in lingual/palatal direction.
• In extreme cases, the entire alveolar process might be lost following tooth loss.

Basic Bone Biology

• Bone is a specialized connective tissue that is mainly characterized by its mineralized organic matrix.
• Matrix is comprised of collagenous and non-collagenous proteins.
• Within the matrix, ions of calcium and phosphate are laid down in the ultimate form of hydroxyapatite.
• This composition allows the bone tissue to resist load, protect highly sensitive organs, participate as a reservoir of minerals that contribute to systemic homeostasis of the body.

Bone Cells

• Osteocytes.
• Osteoblasts.
• Osteoclasts.
• Osteocytes: Stellate-shaped cells that are trapped within the mineralized bone matrix but remain in contact with other bone by thin cellular processes.
• Osteocytes are organized as a syncytium (multinucleate mass of cytoplasm resulting from the fusion of cells) that provides a very large contact area between the cells and the non-cellular part of the bone
• Osteoblast are the primary cells responsible for the formation of bone.
• Osteoblast synthesize the organic extracellular matrix components and control the mineralization of the matrix
• Osteoblast are fully differentiated cells and lack the capacity for migration and proliferation
• Osteoclast are multinucleated cells that originate from hematopoietic precursor cells.
• Osteoclast degrade bone to initiate bone remodeling and mediate bone loss in pathologic conditions by increasing their resorptive activity.

Two Types of Healing

• The healing of bone tissue includes both regeneration and repair phenomena, depending on the nature of the injury.
• Repair involves the healing of an injured tissue that leads to the formation of a tissue that differs in morphology or function from the original tissue.
• Tissue regeneration leads to complete restoration of morphology and function.
• Repair: Heals the injury but may leave a scar or not work like before.
• Regeneration: Heals the injury by making new tissue that's just like the original-no scar.

Repair

• Trauma to bone tissue whether repeated stress or a single traumatic episode, most commonly results in fracture
• Repair happens in phases.
• First, the inflammation phase begins immediately after tissue injury and lasts for approximately 2 weeks.
• The initial step in the repair process is the formation of a blood clot.
• Cytokine release from injured cells recruits inflammatory cells to the area, where macrophages begin phagocytosis of damaged tissue and cells.
• Second, the reparative phase is characterized by the formation of a soft callous where new bone matrix and cartilage scaffolding begins to form.
• The process of soft to hard callus formation occurs approximately 6-12 weeks from the time of bone fracture.
• Third, the remodeling phase is when the bone matrix and cartilage are remodeled into mature bone.
• The time for the remodeling stage varies depending upon individual bone metabolism, but usually require months from the time of injury.

Regeneration

• Over time bone sustains damage from mechanical strain, overloading, and other forms of tissue injury that results in microfractures and other defects in the bony architecture.
• In order to prevent greater injury, the bone undergoes a natural remodeling process to regenerate or renew itself.
• Bone resorption by osteoclasts occurs first over a period of 3–4 weeks, along with cellular signaling to promote osteoblast recruitment to the area.
• Osteoblasts then form bone for a period of 3–4 months, with a quiescent period between bone resorption and formation, called the reversal phase.
• Trabecular bone undergoes a significantly higher degree of bone turnover than cortical bone.

Periosteum

• is a fibrous sheath that lines the outer surface a long bone's shaft, but not the articulating surfaces.
• Endosteum lines the inner surface of all bones.
• The periosteum consists of dense irregular connective tissue and are divided into: a dense, fibrous, vascular layer (the “fibrous layer") and an inner, more loosely arranged, connective tissue inner layer (the “osteogenic layer").
• The fibrous layer is mainly formed of fibroblasts, while the inner layer contains osteoprogenitor cells.

Peri-Implant Mucosa

• The soft tissue that surrounds dental implants.

Osseointegration Defined

• A direct structural and functional connection between ordered. living bone and the surface of a load-carrying implant.”

Implant Installation Basic Rule

• The less traumatic the surgical procedure and the smaller the tissue injury in the recipient site during implant installation, the more expeditious is the process through which new bone is formed and laid down on the implant surface which involves: Incision of the mucosa, The elevation of mucosal flaps and the separation of the periosteum from the cortical plates, The preparation of the canal in the cortical and spongy (cancellous) bone of the recipient site, and The insertion of the titanium device (the implant) into this canal.
• A series of mechanical insults and injury to both the mucosa and the bone tissue.
• The host responds to this injury with an inflammatory reaction, the main objective of which is to eliminate the damaged portions of the tissues and prepare the site for regeneration or repair.
• Injury to the hard tissues must be added the effect of the so-called “press fit”, that is when the inserted implant is slightly wider than the canal prepared in the host bone in such situations: The mineralized bone tissue around the implant is compressed and exhibits a series of microfractures.
• The blood vessels, particularly in the cortical portion, of the canal will collapse, the nutrition to the bone in this portion is compromised.
• The affected tissues most often become non-vital.
• The injury to the soft and hard tissues of the recipient site, however, also initiates the process of wound healing that ultimately ensures that: The implant become “ankylotic" with the bone, that is osseointegrated and a delicate mucosal attachment is established and a soft tissue seal forms that protects the bone tissue form substances in the oral cavity.

Process of Osseointegration

• The wound chambers were first occupied with a coagulum (blood clots).
• With the in-growth of vessels an migration of leukocytes and mesenchymal cells the coagulum was replaced with granulation tissue.
• The migration of mesenchymal cells continued and the granulation tissue was replaced with a provisional matrix, rich in vessels, mesenchymal cells, and fibers.
• The process of fibroplasia and angiogenesis had started. (after 4 days).
• Formations of newly formed bone could be recognized already during the first week of healing.
• The newly formed woven bone projected from the lateral wall of the but bony bed (appositional bone formation; distance osteogenesis (Development of bones) but de novo (beginning) formation of new bone could also be seen on the implant surface, that is at a distance from the parent bone (contact osteogenesis). (after 4 weeks).
• During subsequent weeks, the trabeculae of woven bone were replaced with mature bone, that is lamellar bone and marrow (bone remodeling). (after 6-12 weeks)

Healing Process

• After 1 week of healing substantial amounts of old bone occupied the marginal portion of the surgically prepared site, this bone tissue appeared to be in close contact with the implant device, newly formed bone occurred on the surface of old bone tissue, while areas of bone resorption could be identified in adjacent regions of the tissue wound.
• 2-week interval remnants of old bone apparently still remained in the marginal portion of the implant site, Areas of hard tissue resorption (Howship's lacunae) could be found immediately adjacent to as well as at a distance from the implant, minute areas of newly formed bone occurred on or immediately lateral to the surface of the implant device- This formation of woven bone was the first sign of what may be called osseointegration.
• 4-week interval the healing process features of modeling and remodeling were pronounced, in some areas close to the implant surface resorptive processes were discernible, while in adjacent areas woven bone had formed.
• 6-week interval large amounts of newly formed woven bone but also lamellar bone and marrow, were present in close proximity to the implant device. This kind of newly formed hard tissue was apparently part of a more stable "bone-implant contact", in other words osseointegrations.

Summarized Healing Process

• 1 Week- Old bone surrounds the implant and touches it. New bone starts forming on top of the old bone, some bone resorption is seen nearby.
• 2 Weeks- Old bone is still present. Bone resorption areas appear (Howship's lacunae). Small amounts of new woven bone form near the implant-early signs of osseointegration.
• 4 Weeks: Active bone modeling and remodeling. Bone resorption continues in some spots, while woven bone forms in others close to the implant.
• 6 Weeks: Significant new bone growth (woven and lamellar bone) is seen around the implant, indicated stable bone-implant contact a more complete osseointegration.

Anatomical Considerations in Dental Implants

• Bone Density Comparison
• Anterior Mandible - Highest density (mean ≈ 1.11 g/cm²)
• Anterior Maxilla - Moderate density (mean ≈ 0.55 g/cm²)
• Posterior Mandible - Lower than anterior sites
• Posterior Maxilla - Lowest density (mean ≈ 0.31 g/cm²)
• Bone density trend: Anterior Mandible > Anterior Maxilla > Posterior Mandible > Posterior Maxilla
• Mandible heals faster than the maxilla, especially in the first 3 weeks.
• Cortical Bone Thickness
• Thin Maxilla - mostly <1 mm
• Thicker Mandible, ranges 0.62 mm to 3.65 mm (mostly >1 mm)

Landmarks to Consider

• Maxillary Sinus.
• Nasal Cavity.
• Nerves and Foramen.
• Incisive Foramen.
• Inferior Alveolar Canal.
• Mental Foramen.
• Mylohyoid Ridge.
• B-L width.
• M-D width.
• Blood Supply.
• Maxillary Sinus; pyramidal in shape.
• Pneumatization (the presence of air-filled cavities, or air cells, within a bone) and is possibly the result of atrophy caused by reduced strain from occlusal function.
• Size expands with age.
• Schneiderian membrane: membrane that lines the walls of the maxillary sinus.
• The average volume of a sinus is about 15 ml (range between 4.5 and 35.2 ml).
• Nasal Cavity Floor = Hard palate bones (palatine process of maxilla + horizontal plate of palatine bone).
• Incisive Foramen: Located behind maxillary central incisor, transmits nasopalatine nerve + greater palatine artery/vein.
• Inferior Alveolar Canal: Runs within the mandible; contains inferior alveolar nerve, artery, and vein; Starts: mandibular foramen Ends: mental foramen.
• Mental Foramen: Anterior mandible, transmits mental nerve and artery, sensory for chin, lower lip, labial gingiva.
• Mental Nerve: Sensory nerve which provides sensation to the front of the chin and lower lip, branch of the mandibular division of the trigeminal nerve.
• Mylohyoid line: Ridge on the internal surface of the body of the mandible, Location of the origin of the mylohyoid muscle.
• B-L Ridge Width: 1mm buccal.
• M-D Ridge Width: Tooth to implant 1.5mm, Implant to implant 3mm.
• Requirements for "State of the Art" Implant Systems.
• Suitable for various surgical indication.
• Can be used with advanced procedures (e.g., bone augmentation).
• Offers a wide range of prosthetic solutions.
• Aesthetic in both white and pink tissue zones.
• Easy to handle.
• Designed for long-term success.
• Endosseous Parts: Narrow, Regular, Wide, Extra Wide.
• Abutment Selection: Based on individual needs, independent of implant diameter, allows free combination (abutment → implant), reduces stock needed.
• Planning: Concept for implants and prosthodontics, conventional alternative, pre-treatment, rule out of contra-indication.

Surgical Steps

• Atraumatic and sterile preparation of the implant bed by hand, by machine or combined.
• Implant-congruent cavity.
• High Initial stability.
• Simple surgical technique.
• Short surgical treatment.

Surgical Instruments

• 1. Step: Machine - driven instruments with internal and external cooling.
• 2. Step: Final preparation by hand.

Implant Placement Steps (First Stage Surgery)

• 1. Preparation: Set implant engine to recommended value, anesthetize the surgical site.
• 2. Incision & Flap: Make a crestal incision, Open the flap and detach soft tissue.
• 3. Site Selection & Preparation: Choose implant location considering adjacent teeth and bone width, optional: smooth the bone.
• 4. Initial Drilling: Mark site with starter drill, then use 2.0mm drill (11.5mm stopper).
• Use pilot drill and gauge hole depth, insert parallel pin and gauge to verify angulation and occlusion, adjust direction if needed with Lindemann drill and widen cortical bone with pilot drill.
• 5. Widening & Depth Drilling: Use 2.7mm straight drill, select UF drill size based on fixture, gradually increase width/depth with pumping motion and irrigation, low-speed, no-irrigation drilling for bone collecting (50-150 rpm).
• 6. Bone Hardness Considerations: D1 (Hard): Tap & Profile drill, D2 (Medium): Profile drill, D3 (Soft): UF drill.
• 7. Fixture Insertion: Remove ampoule cap, connect fixture driver, insert fixture at 35 Ncm torque and secure with torque gauge and open wrench.
• 8. Final Steps: Bone level placement: subcrestal (0.5-1mm) , tighten cover screw with 1.2 hex driver, close flap, key and interrupted sutures, allow 3 months for osseointegration.
• Second Stage Surgery: Access the Implant.
• Use explorer to find center of cover screw, use blade or tissue punch to uncover implant and make a small incision if needed.
• Healing Abutment: Remove cover screw, install healing abutment with 1.2 hex driver and allow 1 month for soft tissue healing.
• Final Step: Remove healing abutment for impression-taking. Small access, no traumatization during 2nd-stage surgery, minimizing the intervention due to taper connection.

Advantages

• Minimal trauma during second-stage surgery.
• Tapered connection minimizes intervention.
• Strong primary stability even in soft bone.
• Diagnostic procedures.
• As a result of a biomechanical study, Sammartino suggested a distance of 1.5mm from the Inferior Alveolar Nerve (IAN) to prevent damage under biomechanical stress.

Contraindication

• 1. Intraoral Contraindication.
• 2. Temporary Limiting Contraindications.
• 3. General Medical Contraindications.

Intraoral Contraindications:

• Unfavorable intermaxillary and occlusal relationships.
• Dysgnathia: Abnormalities beyond teeth and jaws.
• Parafunctional habits: Bruxism, tongue-thrusting.
• Pathologic conditions in the alveolar bone: Root fragments, cysts, foreign bodies, granuloma, inflammatory manifestations.
• Radiation therapy: Weakened regenerative processes in the jaw.
• Pathologic changes in oral mucosa: Leukoplakia (white patches), Lichen Planus (inflammatory skin disease), Xerostomia (reduced saliva flow).
• Macroglossia: Enlarged tongue due to long-term edentulism.
• Endocrine disorders: Myxedema (thyroid hormone deficiency), Acromegaly (pituitary gland hyperfunction).
• Unrestored teeth: Poor oral hygiene; patient must maintain good oral hygiene and have all teeth restored.

Temporary Limiting Contraindications:

• Acute inflammatory diseases and infections.
• Pregnancy.
• Certain medications.
• Physical and psychic conditions.

General Medical Contraindications

• General/nutritional conditions: Age, malnutrition (significant risk).
• Life expectancy: Must be at least 5 years.
• Current medications: Corticosteroids, immunosuppressants, long-term antibiotics (consult with physician).
• Metabolic disorders: Juvenile diabetes (type 1) is an absolute contraindication; Type 2 is relatively contraindicated, hyperthyroidism.
• Hematologic disorders: Anemia, reduced host defense, hemorrhagic diathesis (blood clotting issues).
• Cardiac and circulatory disturbances: Preoperative knowledge of any cardiac disorders needed.
• Osseous metabolic disturbances: Osteoporosis (relative contraindication), collagen disorders, rheumatoid arthritis, methotrexate use.
• Dental implants as bacterial focus.
• Heart valve prostheses, bacterial endocarditis, vascular replacements, cardiac bypass, and pacemaker: Do not pose serious risks but need consideration.

Medical/Dental History Questionnaire

• A dentist can begin planning for implant therapy only after reviewing the patient's responses to a comprehensive medical and systemic questionnaire to ensure there are no apparent contraindications.
• Informed Consent.

Special Diagnostic Procedures:

• 1. Radiographic Analysis.
• 2. Mounted Study Model Analysis.
• 3. Measurements of Mucosal Thickness.
• Radiographic Analysis:
  • 1. Peri-apical Radiograph:
    • Advantages:
      • Pre-surgical phase: High-resolution planar image of a limited jaw region; rules out dental disease, identifies critical structures.
      • Surgical phase: Determines implant depth, position, and orientation.
      • Post-prosthetic phase: Provides high-quality images of the implant and surrounding bone.
    • Disadvantages:
      • Pre-surgical phase: Limited in assessing bone quality/quantity and spatial relationship with vital structures.
      • Post-prosthetic phase: Limited depiction of implant-bone interface in some regions.
  • 2. Panoramic Radiograph:
    • Advantages:
      • Pre-surgical phase: commonly used, complete imaging of both jaws in one film. Uses zonography (limited-angle tomography) to modify panoramic x-ray machine for cross-sectional jaw images, helping assess bone quantity and critical structure distances.
    • Disadvantages:
      • Inherent magnification (15-22%), patient positioning errors, less resolution compared to periapical images, and inability to identify disease or assess bone density at the implant site.
  • 3. Cone Beam Computed Tomography (CBCT):
    • Uses X-ray CT with divergent cone-shaped beams to capture 3D images with low radiation and high accuracy.
    • Essential for treatment planning and diagnosis in implant dentistry and other medical fields.
  • 4. Navigation System:
    • Allows precise 3D positioning of planned implants before insertion, ensuring fast, minimally invasive, and predictable procedures.
    • Enables the fabrication of the restoration before surgery, which can be placed immediately after surgery. Radiographic Template.
• Used in conjunction with study models to aid in analysis.

Study Model Cast

• Used to assess the maxillo-mandibular relationship and inter-arch distance.

Anatomical Considerations

• 1. Available Bone:
  • Quantitative: Measures height, width, and length of bone.
  • Qualitative: Assesses bone quality for both surgical and prosthetic purposes.
• 2. Soft Tissue Situation: Evaluates the condition of the surrounding soft tissues.
• 3. Mandibular Canal: Ensures proper positioning away from critical structures.
• 4. Maxillary Sinuses: Checks proximity to sinuses for implant planning. Classification of the Degree of Resorption of the Edentulous Jaw - Lekholm and Zarb

• D1 – Thick Compact Bone Location: Anterior segment of the atrophic edentulous jaw. Advantages:

• Excellent primary stability.

• Broad implant-bone interface.

• Use of short implants possible.

• Disadvantages:

  • Poor blood supply = longer healing time.
  • Often limited bone height (affects implant-crown ratio).
  • Risk of overheating during bed preparation.

• D2 – Thick Porous Compact Bone with Dense Trabecular Core

  • Location: Anterior & posterior mandible, palatal aspect of anterior maxilla.
  • Advantages:
    • Reliable primary stability.
    • Good blood supply and healing tendency.
    • Easy implant site preparation.
  • Disadvantages:
    • None noted.

• D3 - Thin Porous Compact Bone with Loosely Structured Cancellous Bone

  • Location: Anterior facial maxilla, posterior maxilla & mandible

•   - Advantages:
       - Adequate blood supply.
    - Disadvantages:
       - Difficult implant bed preparation (requires careful widening).
       - Reduced bone contact-may require more implants.
  

• D4 – Loose, Thin Cancellous Bone Location: Maxillary tuberosities, post-osteoplasty D3 areas. Advantages:

• None noted. Disadvantages:

• Poor primary stability.

• Minimal implant-bone contact-more implants needed.

• Very technique-sensitive.

• Implant-Natural Tooth Connection

• -- Yes, implants can be connected with natural teeth, but with caution.

• Connection types:

• Rigid or non-rigid connectors are used in fixed partial dentures.

• This immobilizes the natural tooth, preventing physiological movement that could compromise implant integrity.

Biological Bone Threshold (BBT)

• A minimum BBT of 1.5 mm is essential to:
• Prevent gingival margin recession, especially in the esthetic zone.
• Ideal Implant-Bone Dimensions While specifics weren't detailed in your input, general ideal conditions include: Minimum 1.5 mm of bone around the implant for healthy gingival margin and Sufficient bone height and width to ensure long-term stability,and Proper bone quality(preferably D2) for optimal osseointegration and healing