Implant Terminology N. PDF

IMPLANT TERMINOLOGY Rola Shadid, BDS, MSc, P. Board, Associate Prof., Fellow AAID, American Board of Oral Implantology 1  Outline IMPLANT TERMINOLOGY IMPLANT IMPLANT...

IMPLANT TERMINOLOGY Rola Shadid, BDS, MSc, P. Board, Associate Prof., Fellow AAID, American Board of Oral Implantology 1  Outline IMPLANT TERMINOLOGY IMPLANT IMPLANT IMPLANT MODALITIES TYPES SURGERY PROS. Root form 1 piece vs 2 1 stage vs 2 Pros Root form, types piece stage vs attachmnet subperioste Implant body Tissue level regions immediate s. al, balde…. vs bone loading fabrication level S ja /  Implant modalities Implants used Rarely used nowadays Endosteal Subperiosteal Transosteal Root form Blade/plate form These are the most commonly used implants nowadays. Rarely used nowadays 9 Endosteal implants Refers to materials or devices placed inside the bone. ▪ Endo-within Osteal-bone v & ▪ Alloplastic material surgically inserted into a residual bony ridge, primarily to serve as prosthodontic foundation Types of Root Form Endosteal Implants 1. Screw-Type Implants: Resemble the shape of a root. Example: Screw implants. 2. Blade Implants: Resemble the shape of a blade. 10  Endosteal implants Root form Blade/plate form Usage: Rarely used nowadays. Why Bladed Implants Are Rarely Used Justification for use: 1. Challenges with in Insertion & Removal: Severe bone resorption, where the vertical height above In cases like inflammation around the implant, removing a bladed implant can: the ID canal is very limited. Be very difficult. In such cases, bladed implants can be an option. Cause severe bone destruction, resulting in significant bone defects. However, alternative solutions exist even for cases of limited 2. Advantages of Root Form Implants: bone height, such as: User-friendly: Easier to insert and remove. 1. Short implants: Proven to be very successful. Simple removal: Reversing and unscrewing are sufficient. 2. Bone augmentation: Increases bone height to allow placement of standard-length implants. Insertion method: Installed using clockwise motion. 11  Subperiosteal implants Definition and Placement Used in specific cases. These implants consist of a framework placed: =S : mucosa - submucosa Underneath the periosteum (gum tissue). Above the bone (without entering the bone). Features and Design 1. Framework Securing: Firmly attached to the bone through mechanical fit and retention. 2. Customization: Unlike root form implants, which come in prefabricated sizes and lengths, subperiosteal implants must be: Custom-made to fit the patient’s jaw and existing bone structure. Material and Components The framework is typically made from: Chrome cobalt or titanium. Features metallic posts that: Protrude above the gum tissue. Serve as attachment points for the prosthesis. 12 Indications Severe vertical bone resorption (e.g., edentulous mandible with significant bone loss). In such cases, there are two options: 1. Bone Augmentation: Characteristics Requires massive augmentation: Custom-made: Medical conditions and financial cost must be considered. Designed specifically for each patient. May require invasive surgical procedures and external bone sources. Success rate is very low. Alternative: Use short implants combined with bone augmentation in some cases. Drawbacks: Risk of post-surgical scarring due to customization and the surgical process. 2. Subperiosteal Implants: When to Use: Used when bone augmentation is not feasible or desired. Advantages: Acts as a rescue solution for severe bone loss in the edentulous mandible or maxilla. 3. All-on-Four Implants (Mandible): When to Use: Posteriorly: When bone level above the ID canal is minimal (3–4 mm, negligible). Anteriorly: Exploit abundant bone in the inter-foraminal area (safety area from one mental foramen to the other). How to Use: Place four implants in the safety area: Anterior implants: Positioned vertically. Posterior implants: Can extend 2–3 mm above the inferior mandibular border if necessary. Advantages: High success rate. Can support a 12-unit bridge for full-arch restoration. 4. Tilted Implants (Mandible) 5. All-on-Five or All-on-Six Implants (Maxilla) Fabrication of Subperiosteal Implants Process: Implants are custom-made using: Traditional impressions. Digital impressions.  Transosteal Implants Definition and Placement Transosteal implants are designed as plates that fit on the lower border of the mandible. Stabilized by screws that penetrate through the inferior border of the mandible to the bone. Disadvantages Surgically invasive: Requires extensive surgical procedures. Custom-made: Each implant must be tailored to the patient’s anatomy. Costly procedure: High expense compared to other implant options. Current Usage No longer used due to advancements in implant techniques and availability of better alternatives. Alternatives: Root form implants in the anterior mandible. Bone augmentation when necessary. Why It’s Obsolete Modern implantology offers less invasive and more effective solutions for restoring function and aesthetics. Techniques such as All-on-Four or Tilted implants provide more success with lower risks. 16  Lecture Outline ▪ Introduction ▪ Why dental implants? ▪ Terminology ▪ Root form implants types ▪ Implant body regions ▪ One-piece vs two-piece implants ▪ Tissue-level vs bone-level implants ▪ Implant surgery ▪ Prosthetic attachments ▪ Prosthetic fabrication ▪ Biologic width around teeth & implants 20 Case 1: Heavily Restored, Endodontically Treated Lower 6 Molar Problem Overview: Patient has a heavily restored, endodontically treated lower 6 molar. Lingual portion of the tooth has a severe defect causing fracture. Composite filling extends 3–4 mm subgingivally. Treatment Options: 1. Post, Core, and Crown with Crown Lengthening: Drawbacks: Risk of exposing the furcation area, leading to: Lower survival rate for the tooth. Difficulty maintaining oral hygiene on the lingual side. Potential damage to the lingual nerve. 2. Implant Placement (Preferred Option): Advantages: Higher survival rate compared to crown lengthening. Less complicated (avoids multiple procedures like post, core, and crown lengthening). Procedure: Extract the tooth and perform immediate implant placement in the same session. Load the implant immediately if primary stability is achieved. One-stage surgery: Implant does not need to be submerged, avoiding a second-stage procedure. Suitability: Ideal for patients seeking a minimally invasive procedure that reduces surgical steps. 3. Three-Unit Bridge (Alternative Option): Advantages: A practical and realistic option with similar survival rates to implants. Drawbacks: Requires preparation of sound abutments, which compromises healthy teeth. Leads to bone resorption at the site of the extracted tooth, unlike implants, which help preserve the bone. Case 2: Stabilization of Lower Denture Problem Overview Common complaint among denture-wearing patients is the instability of the lower denture. Causes: Limited surface area for retention in the mandible compared to the maxilla. Tongue movement and space reduce denture stability. Solution: Implant-Supported Lower Denture Approach: Place 2 implants in the canine or lateral incisor region to stabilize the lower denture. Advantages: 1. Cost-Effective: Only 2 implants are required, making it a budget-friendly option. 2. No Need for New Denture: If the existing lower denture fits well, it can be adapted to work with the implants. 3. Minimally Invasive: Straightforward procedure with minimal surgical intervention. 4. Improved Quality of Life: Significant enhancement in: 31 : 15 Stability and retention of the denture. sig this 2 N Comfort, aesthetics, and final functional outcome. slogist Case 3: Missing Upper First Premolar Problem Overview Patient has a missing upper first premolar. Treatment options need to consider preserving the health of adjacent teeth. Treatment Options 1. Three-Unit Bridge: Procedure: Prepare the adjacent canine and premolar to support the bridge. Advantages: Straightforward and common solution. Drawbacks: Canine is sound, and premolar has only a very small filling. Preparation of these teeth compromises their longevity, increasing risk of: Caries, Periodontal problems, Endodontic issues. 2. Single Implant (Preferred Option): Advantages: Eliminates the need to prepare adjacent sound teeth. Provides a better long-term solution by preserving the health and integrity of neighboring teeth. Procedure: Place a single implant to restore the missing premolar without affecting adjacent teeth. Conclusion: While a three-unit bridge is an acceptable solution, the single implant is the preferred option for ensuring optimal outcomes with minimal impact on the surrounding dentition. Case 4: Missing Upper Second Molar Additional Notes: Sinus Pneumatization: Question: Is it important to replace this tooth? Observed in cases with limited vertical bone height. Considerations: Solution: Sinus lifting to create sufficient vertical height for implant placement. Replacement depends on the patient’s age, bite forces, and the presence/ A predictable surgical procedure with excellent long-term outcomes when done functionality of the lower second molar: properly. SR > 95% If the patient is young and the lower second molar exists and functions: Conclusion: Replacement is important to ensure efficient biting and prevent: Replacement of the upper second molar is critical for young patients with existing lower Shifting or loss of the lower molar. molars. If the lower molar is absent, replacement becomes less critical. Implant placement with crown is the preferred treatment, supported by sinus lifting when bone height is inadequate. Treatment Options: Cantilever bridges can be considered but have significant risks and limitations, particularly with long-term success and stress on adjacent teeth. ↳ 1. Implant with Crown (Preferred Option): premolar 5 Advantages: Pre-surgery 2 ys Post-op NotFunctional Benefit Ensures efficient functionality. Predictable procedure with high success rates. Bone Augmentation: Sinus Lifting required when vertical bone height is insufficient: Preoperative bone height: 3.7 mm. or closed Crestal technique used (minimally invasive without external window). Postoperative bone height: Increased to 11–12 mm after 2 years. Outcome: Implant in function restored the second molar, improving: Efficiency of biting. Stabilization of the opposing second molar. 2. Removable Partial Denture (RPD): Drawbacks: Poor patient compliance (over 95% rejection) due to discomfort. Inefficient for replacing a single missing tooth.  RPD is a viable option, implants with a supported bridge or individual crowns provide superior functionality and stability. In this case, three implants are recommended to replace each missing tooth, ensuring optimal support, longevity, and patient satisfaction. Dr. Rola Shadid Case 6: Failing Maxillary Teeth Due to Periodontal Disease Problem Overview: Patient presents with failing maxillary teeth due to periodontal causes (Grade 2 or 3 mobility). Teeth are very mobile and classified as hopeless. Solution: Hopeless teeth must be extracted and replaced with a restoration. Treatment Options: 1. Immediate Denture: Procedure: Extract teeth and provide a complete immediate denture in the same session. Considerations: Suitable if the patient is willing to adapt to a temporary solution for 2–3 months while healing occurs. 2. Implant Placement with Provisional Prosthesis: Procedure: Extract teeth and perform immediate implant placement. Provide the patient with a fixed provisional prosthesis in the same session. Requirements: Perform proper socket cleaning to ensure healthy bone support. Distribute 7 implants across the maxilla for optimal support. Fixed provisional prosthesis must meet occlusal and functional criteria to ensure stability and comfort. Key Considerations for Immediate Implant Placement: Suitability: Depends on the patient’s ability to tolerate a fixed provisional prosthesis immediately after surgery. Conclusion: Bone condition and implant stability are critical for success. Immediate dentures are a common option for patients seeking a temporary solution during healing. Provisional Prosthesis: For long-term function and aesthetics, immediate implant Ensure it is functional and well-distributed over the implants. placement with provisional prosthesis is preferred, provided bone and implant stability are adequate. Must account for any occlusal forces to avoid implant failure.  Problem Overview: Patient retains 3 teeth (centrals and lateral) with good root ratio. Classified as Class 1 Kennedy Classification. Goal is to preserve the existing teeth and restore function and aesthetics. While partial dentures can be a temporary solution, implants with a fixed supported prosthesis offer a superior long-term outcome, ensuring stability, aesthetics, and functionality. The decision aligns with the patient’s condition and the desire to maintain the existing teeth. Rola Shadid 29 Lecture Outline ▪ Why dental implants? ▪ Terminology ▪ Root form implants types ▪ Implant body regions ▪ One-piece vs two-piece implants ▪ Tissue-level vs bone-level implants ▪ Implant surgery ▪ Prosthetic attachments ▪ Prosthetic fabrication ▪ Biologic width around teeth & implants 31  Osseointegration Definition: Osteointegration was defined by Brånemark (the father of modern implant dentistry) as: The fusion of bone with the surface of the implant threads. ▪ A direct contact A direct contact of living bone with the surface of an implant at the light microscopic level of magnification of living bone Question: How is osteointegration examined? with the surface 1. Theoretical Approach: By removing the implant and examining it under a microscope to observe: of an implant at Bone attached to the implant surface. Evidence of bone integration into implant threads. Limitations: the light This is not clinically applicable or logical, as it requires removing the implant. 2. Clinical Approach: microscopic level Instead of removing the implant, clinicians rely on: (1) Radiographic evidence: To confirm bone integration around the implant. of magnification ↳ (2) Stability tests: ISQ (Implant Stability Quotient) or resonance frequency analysis. Manual testing for mobility or loosening. 32  Rigid fixation Definition of Rigid Fixation: Rigid fixation means the implant is solid and stable enough to support a crown or prosthesis. This stability is achieved due to osteointegration, where the bone fuses with the implant threads. ▪ A clinical term that implies no observable movement of the implant when a force of 1 to 500 g is applied Connection Between Rigid Fixation and Osteointegration: The term rigid fixation indicates that the implant has reached sufficient osteointegration to withstand functional loads and support restorations. Question: Is there an objective technique to determine if the implant is ready to receive a prosthesis? Answer: Yes, there are devices and techniques to measure implant stability and readiness for prosthesis: ISQ (Implant Stability Quotient) using resonance frequency analysis (RFA) — Osstell® Device - Bone stiffness 1 Manual testing for mobility or stability. ↳. 3 months S5 These methods provide measurable indicators to confirm the implant’s readiness for restoration. 33  🔶 Osstell® Device: Usage and Application The Osstell® device is a diagnostic tool used to measure the stability of dental implants and assess their readiness to support prosthetic restorations. Principle of Operation: The Osstell® device uses Resonance Frequency Analysis (RFA) to determine implant stability. A SmartPeg is attached to the implant, and the device emits vibrations to measure the resonance frequency. Results are provided as an Implant Stability Quotient (ISQ), which ranges from 1 to 100: Higher ISQ values indicate greater stability. When to Use: 1. Immediately After Implant Placement: To assess primary stability, which is critical for immediate loading protocols. 2. During the Healing Period: To monitor secondary stability (bone remodeling and osteointegration). Helps decide the right time for placing the final prosthesis. 3. Before Prosthetic Loading: Ensures the implant has achieved sufficient stability to withstand functional forces. Benefits: Objective Measurement: Eliminates subjectivity compared to manual testing. Mesial-Distdog Predictability: Assesses the success of immediate loading or delayed protocols. Bucco-Lingual Age Early Detection: Identifies implants with insufficient stability, allowing for intervention before failure. Guides Clinical Decisions: Helps determine the optimal timing for prosthetic loading. Clinical Guidelines for ISQ Values: High Stability: ISQ > 65 (Ready for immediate or early loading). Moderate Stability: ISQ 60–65 (Requires careful assessment before loading). Low Stability: ISQ < 60 (Implant is not stable enough for loading; additional healing time or intervention is needed). 20 implant is fail & /l sljblil, like Fail + < 50 Je. / iS It d The Osstell® device is a reliable tool for ensuring implant success by providing objective and reproducible measurements of implant stability, aiding in both surgical and prosthetic decision-making. Root form implants Three primary types of root form body endosteal implants based on design; ▪ cylinder, 1.Cylindrical Implants: Previously used extensively in implantology. Design involves press-fit placement: ▪ screw, Osteotomy Implant is pressed into a pre-prepared hole inside the bone. Drawbacks: surface - depend BCz it. on area for sec. Stability ▪ combination Lower primary stability compared to screw implants. Rarely used in modern practice due to advancements in screw implant technology. 2.Screw Implants: ~ Currently, the most commonly used implant design. Placement involves screwing the implant into the bone, using threads for fixation. Advantages: of mechanical - BC2. engagement of threads Provides much higher primary stability compared to cylindrical implants. Widely used because of its predictability and better clinical outcomes. L 3.Combination Implants (Cylindrical + Screw): Emerging implants in modern implantology. Key Feature: In cases of bone loss, particularly in coronal third of root form, these implants are easier to clean & maintain compared to fully threaded (screw) implants. 37  Implant Body The selection of implant design, length, and width depends on: Bone quality and quantity. Available space. Functional and aesthetic requirements. ▪ Cylinder vs solid screw ▪ 7 to 16 mm ▪ narrow, standard, wide Implant Lengths: Vary depending on clinical needs: (1) Standard Lengths: Range from 7 to 16 mm. (2) Short Implants: Can be as short as 4 mm, used in cases with limited bone height. (3) Zygomatic Implants: Longer than 16 mm, designed for unique anatomical situations requiring anchorage in the zygomatic bone. * Implant Widths: 1. Narrow Implants: Suitable for areas with limited space, such as anterior regions. 2. Standard Implants: Commonly used for most cases. 3. Wide Implants: Used in areas requiring greater surface area for stability, such as molar regions. 4. Mini-Implants: Often used for temporary support or in cases with very limited space. A Additional Configurations: o more comm prefer in immediate implant placement BCZ of higher primary stability , rApexitaped Tapered Implants: Designed to mimic the natural shape of tooth roots and provide enhanced stability in soft bone. Parallel-Walled Implants: Provide uniform surface contact with the bone, often used in dense bone areas.↳ Apexi39 Lecture Outline ▪ Why dental implants? ▪ Terminology ▪ Root form implants types ▪ Implant body regions ▪ One-piece vs two-piece implants ▪ Tissue-level vs bone-level implants ▪ Implant surgery ▪ Prosthetic attachments ▪ Prosthetic fabrication ▪ Biologic width around teeth & implants 40 Implant Body Regions 3.Crest Module (Neck): Si jtl 3 : 40 #13 plateIblad/plant form Uppermost portion connecting the implant to the prosthesis. Features anti-rotational elements and allows attachment of abutments or crowns. Diffient shape and > - Distance btw it 2.Body (Middle Section): threaa Central part containing the threads, optimizing bone contact and stability. "Surface Contributes to primary stability and initial fixation. primary a Stability * Antirotational area 1.Apical Portion (Apex): flat SurfaceHoles The tip of the implant located within the bone. The design of the apex can vary: Rounded, flat, or tapered to adapt to different bone densities and anatomical considerations. Features anti-rotational elements, ensuring enhanced primary stability during implant placement. 41  Types of Connections: ▪ External connection: superior to the coronal portion of the implant. ▪ Internal connection: inferior to the coronal portion of the implant 1.External Connection: 2.Internal Connection: Anti-rotational features are located above the Anti-rotational features are located implant body (e.g., hexagon). inside the implant body. Commonly used in the past but prone to: Preferred in modern practice due to: Increased stress on screws. & $'i Reduced stress on screws. u internal + screws fixation ( , 1 wil as engagement Potential crown displacement. Improved retention and durability. Modern implants reduce reliance on Preferred for screw-retained bridges with screws by using a conical design multiple implants due to easier alignment and (cone inside cone) in the crest module. passivity of placement, simpler handling, and easier impression-taking. This creates frictional retention through mechanical welding, Designs of Crest Module: stability & minimizing screw use. Can vary based on anti-rotational shapes, including: A newer innovation is the screwless design, which eliminates screws Hexagon. entirely by relying solely on advanced Octagon. J frictional retention systems. While not highly practical in all cases. Conical designs (The Best).  Internal connection Joint Configurations: ▪ Butt joint, consisting of two right-angle flat surfaces making contact with each other ▪ Bevel joint (conical), when the surfaces are angled Flat, right-angle connection between the abutment and implant. Abutment Angled connection (e.g., 5°, 10°, 15°) to enhance load distribution and seal. (flat to flat surface) implant  Thread geometry Types of Threads: Each thread type serves specific clinical purposes, balancing the need for primary stability and optimal load distribution after osteointegration. The selection of thread geometry depends on bone quality and implant location. There are three basic screw-thread geometries: V-thread, buttress (or Features: reverse buttress) thread, and power 1. V-Thread: least common (square) thread designs. Provides high primary stability due to its wedge-like design. Facilitates firm engagement with bone during initial placement. Drawbacks: After osteointegration, it transfers tensile and shear forces to the bone, which may not be favorable for long-term stability. 2. Buttress Thread (or Reverse Buttress): Features: Designed to transfer compressive forces during loading. Reverse buttress threads are engineered to enhance bone support, especially during masticatory forces. Applications: Ideal for implants placed in regions with high occlusal forces, such as molar areas. most 3. Power (Square) Thread: common Surface area Features: Designed to maximize the distribution of compressive stress. Compressive forces are more favorable for bone health and implant success. Reduces micro-movements and enhances load distribution. Advantages: Most suitable for long-term implant stability, especially in softer bone. 45 Lecture Outline ▪ Why dental implants? ▪ Terminology ▪ Root form implants types ▪ Implant body regions ▪ One-piece vs two-piece implants ▪ Tissue-level vs bone-level implants ▪ Implant surgery ▪ Prosthetic attachments ▪ Prosthetic fabrication ▪ Biologic width around teeth & implants 81 One-piece vs two-piece implants 82  ▪ One-Piece Implant: Two-Piece Implant (Most Commonly Used Today): Design: Design: The abutment is built into the implant, leaving no gap between the Comprises a separate implant & abutment, connected by a screw. implant and abutment. Advantages: Advantages: Primary stability management: Suitable for cases with low initial No microgap: Reduces the risk of bacterial colonization and bone stability (e.g.,