Oral Surgery: Dental Implants - Implant 1 PDF

·, \ I... , 'i ' ,1 ~. ·. \ !-~., \  implant body B.N., 2025...

·, \ I... , 'i ' ,1 ~. ·. \ !-~., \  implant body B.N., 2025 ( ·1 t those used ► Dental Implant: It is an artificial metalhc fixture suni ar O. in orthopedics) which is placed surgically into the jaw bone to subStltute for a missing tooth (and its root) It is made by titanium and shaped like a screw~ Restorations such as crowns, bridges or dentures can be attached. Nowadays, zirconia implants are also available :lwUVUJ 1- Ancient implant materials: During the ancient Egyptians era, and in South America in the 18th century _. wood, carved stone and animal teeth. 2- Metallic implants: Gold, platinum, Lead coated platinum, Silver, Vitallium, Stainless steel & Recently titanium. 3- In 1952: Professor Branemark, ac$wedish surgeon, while conducting research into the healing patterns of bone tissue, accidentally discovered that when pure titanium comes into direct contact with the living bone tissue, the two literally grow together to form a permanent biological adhesion. He named it "Osseointegration" Osseointegration: Direct structural and Function~! adhesion (bonding) between implant surface and surrounding bone. This type of connection is considered the most desirable one ( J ~ ~ &nbta-indicatio.n6 ] ► Indications: \) To restore a missing tooth or teeth with a fixed restoration without altering adjacent teeth 2) Severe bone loss that can affect denture retention. I 3) Poor oral muscular coordination 4) Low tolerance of mucosal tissues _ _ _ _ _ _ _ _ _ _ _ Page 1  B.N,l 2025 5) Para-functional habits--+ recurrent $Oreness and denture instability 6) Unrealistic prosthodontic expectation. 7) Active or hyper-active gag reflex precipitated by removable denture. 8) Psychological inability to wear denture, even with adequate one ' 9) Massive bone and tissue loss following surgical removal of tuµiors ► Contra-Indications: Medically compromised patients (uncontrolled Diabetes.....etc) Patients with history of radiotherapy Patients with history of chemotherapy Patients on bisphosphonate treatment Patients with diseases affecting bone metabolism ► Advanta&es: 1) Maintain bone volume 2) Restore and maintain vertical dime~ion 3) Maintajn and improve facial esthetics 4) Improve phonetics 5) Long tenn prosthetic success 6) Maintain masticatory perfonnance 7) Reduce size of the prosthesis 8) Provide fixed prosthesis 9) Improve stability and retentton of removable prosthesis 10) No need to alter the adjacent teeth 11) More permanent replacement 12) Improve psychological health _ _ _ _ _ _ _..:..-__ _ _ Page 2 " I B.N.12025 ► Disadvanta2es: 1) It is inserted through a surgical procedure 2) Overall treatment time is long 3) It is not a lifetime treatment 4) Requires patient compliance regarding maintenance of implants 5) It is an expensive procedure The implant (fixture): it is the actual part that is inserted into the bone. The abutment: it is the core area which is screwed to the implant where the prosthetic part is attached to it. Cen1ent retained restoration Screw retained restoration Abutment is secured with a square Abutment can be either parallel head screw tightened to 32 Nern. (standard) or conical (esthe~cone) in shape. Abutment is secured with an abutment screw that is tightened to 20 ncm. The prosthesis: it is either single crown, fixed partial denture, over denture or any type of restoration connected to the implant and the abutment Imp lan t cornoonents linplant body Cover screw Healing abutment ,,' Abutment (screw retention, cement retention for-attachment) Prot hesi s ·screw Tran sfer copirig X~r~~~'- indirect) Analog. 11. ,;~· , , ---'----·-. f -- - - - - - - - - - - - 3Page  B.N. 2025.. ,,. el"66iffeation I at dental im p~ ' A) According to Natur implant e your won tooth 1- Tooth implants: include transplantation, re-implantation and endodontic endosseous implants. · 2- Non tooth implants: include subperiosteal implants, transosteal implants, endosteal blades and root- form implants. B) According to position 1- Endodontic stabilizer It is a Smooth or threaded metallic pin implant that extends through the root canal into the periapical bone to stabilize the mobile tooth. 2- Mucosal inserts Stainless steel inserts attached to the tissue surface of a removable prosthesis that mechanically engage undercuts in surgically prepared mucosal sites.. " ~. ~--·.... , I '~:-~.......__,..,. -. I '. r I I :J , l,.,, ------------ Page 4  B.N. j 2025 3- Subperioteal implant I~ framework is made of cobalt chromium molybdenum based alloy resting on the alveolar bone beneath the periosteum, with abutment posts and intraoral bars to attach a prosthesis t Indication: ✓ When there is not enough bone in which to place an endosteal implant ✓ Severely atrophied mandible The shape of bone for fi:ame cons~ction is obtained through: ✓ Direct bone impression (2 surgical exposures) ✓ CAD-CAM generated model (only one surgical exposure) what support the implant 4-Transmandibular "Transosteal" dental implants "staple bone plates" Transosteal threaded posts which penetrate the full thickness of the mandible and pass into the oral cavity in the parasymphyseal area The staple bone plate A plate that fits against the lower border of the mandible at the symphysis and has posts rising from it Is used to rehabilitate the ·atrophic edentulous mandible - - - - - - - - - - - - 5Page  B.N.12025 5- Endosteal (Endosseous) implants The implant is placed into the alyeolar bone. Composed of a) Anchorage component (body) b) Retentive component (abutment) Types: I- Root fonn endosteal implants a) Cylinders implant b) Screws (or spiral post) implant II- Blade form (Plate fonn) endosteal implant. Root fonn Implants Blade form (Plate form) Implant a- Cylinders: which may be either It is a wedge shaped implant: compos~d of tapered or baskets (hollowed with head, neck and body with vents which fenestrations) develops fibro osseous integration with bone b- Screws (or spiral post): which It is a mean of utilizing the narrow and/ or may be either solid or hollowed shallow areas of remaining alveolar bone the where dimensions do not permit the use of upper part root form implants. The blade jmplant was become restorable within a month of placement by one the superstructure with the ~N.B.: Ramus frame implant: was designed gingival to be placed in the ramus of the mandible. to not bone > solve the problem that existed in knife edge osseoufi ridges brointeg ration Root form implants are classified accordin2 to desi2n I) One-stage -implant {tissue level implant): be placed in the bone and to immediately project through mucosa into the oral cavity (and to place the healing collar) _ _ _ _ _ _ _ _ _ _ _ Page 6  B.N.12025 II) The two stage (bone level implant): implant requires two surgical procedures. First it is placed in bone to the level of the cort ical plate and the oral mucosa is sutured over it. Then left for a healing period (usually 3 months in the mandible and 6-9 months in the max illa) depending on the quality of bone In a 2nd surgery the mucosa is reflected from the superior surface of the implant and healing collar is placed and project into the oral cavity C) According to the Material into: 1- Non-metallic implants: Ceramics, Polymers or Carbons (which decreases the induced stresses in bone, but of lower strength quality) 2~ Metallic implants: high strength metals. It is one of the most suitable types " ► Titanium is the metal that is well accepted by the body and ~e- bone can grow very close to it "OSSEOINTEGRATION". a) Pure titanium i j b) Titanium alloy: ·~e titanium alloys exist in thrie forms: alpha, beta and alpha beta phases. They all origip.ate when ppre. titanium is heated and mixed with aluminium and vanadium t ; ! { I - - - - - - - - - - - ,Page r  I B.N, 2025 ► Most implants are made from Ti-Alloy. ► Outerlayer is titanium oxide (responsible for the fonnation of the direct bone- implant interface) OR I GRIT Blasted or acid etched surface --+ to roughen the surface and increase the area for bone contact Titanium plasma-sprayed surface (TPS) Titanium coated with Hydroxyapatite or porous ceramic substitute or (tri ca ph) D) AccordinK to Surface Treatment:.I - Titanium oxide surface: coating the implants to make the inert metal a bioactive one. 2- Sand (Grit) blasted surface OR acid etched surface -+ to roughen the surface and increase the area for bone contact 3- Titanium Plasma Sprayed surface (TPS) -+ it has satisfactory results regarding the osseointegration and the clinical prognosis. 4- Hydroxyapatite coating Subtractive means Additive means Grit blasting Plasma spraying Acid etching Hydroxyapatite coating Anodization Sputter-deposition Laser Peening Sol-gel coating Biomimetic reci itation _ _ _ _ _ _ _ _ _ _ _ Page 8  the implant B.N., 202 5 E) According to the Insertion technique: 1- Press fit technique (with Unthreaded implants): the implant sit~ is drilled slightly smaller than the actual implant size, where the implant is pressed into the recipient site with slight friction. 2- Self tapping technique (with Threaded implants): the threads are used to tap its site during insertion. 3- Pre-tapping technique {in case of very dense bone): the implant sites are better to be previously tapped using the bone tap instrument before insertion of the threaded implant F) According to Surgical Stages: 1- Single stage design {none submerged transgingival)(tissue level) : the body of the implant is inserted into the bone with.its abutment portion penetrating through the mucoperiosteum during the healing period. 2- Two stage design {bone level): the implant body is completely embe dded in bone for complete osseointegration. Then exposed and the healing abutment is placed for soft tissue healing before the impression is made for prosthesis fabrication G) According to the time of Installation: 1- Immediate implants (immediate post-extraction): placed into a prepared extraction sqcket immediately following extraction. 2- Immediate delayed implants: placed within 1-6 weeks after the tooth loss. 3- Delayed implants: placed within 6-12 months after tooth extraction, when complete healing and bone remodeling occur. _ _ _ _ _ _ _ _ _ _ _ Page 9  the crown or prothesis B.N. j2025 According to time of Loading: a- Immediately loaded implants: an acrylic resin prosthesis which is designed to be out of occlusion, placed immediately after implant placement, specially in anterior region for esthetic pwposes. I, b- Delayed loading implant: done in maxillary impl~ts after 4-6 months and in mandibular implants after 3-4 months to allow for better Osseointegration C-Progressive loading: performed through the use of a prosthesis that is out of occlusion, and occlusal contact is built gradually _ _ _ _ _ _ _ _ _ _ _ Page 10