Implant Platforms 2024 PDF

IMPLANT PLATFORMS Hesham Nouh, BDS, DSc, MSD, CAGS, FICD Jan 8th 2024 IMPLANT PLATFORMS/CONNECTIONS Different sizes/ shapes, widths and length Platform Neck/Collar Internal Connection IMPLANT PLATFORMS/CONNECTIONS Connection mechanisms: External hex: Resides on the platform Internal hex: Extends wit...

IMPLANT PLATFORMS Hesham Nouh, BDS, DSc, MSD, CAGS, FICD Jan 8th 2024 IMPLANT PLATFORMS/CONNECTIONS Different sizes/ shapes, widths and length Platform Neck/Collar Internal Connection IMPLANT PLATFORMS/CONNECTIONS Connection mechanisms: External hex: Resides on the platform Internal hex: Extends within the implant body Functions of hex: Acts as a retentive mechanism between implant body and abutment Serves as an effective anti-rotation element The hex area is the weakest area in the entire implant body-abutment connection Screw loosening and fracture of implant components have been noted more with traditional external hex than with internal hex IMPLANT PLATFORMS/CONNECTIONS External Connection External Hex (Hexagonal) External Octa (Octagonal) Spline EXTERNAL HEX CONNECTIONS ADVANTAGES AND DISADVANTAGES Advantages Disadvantages Long-term follow-up data are available Higher prevalence of screw loosening Compatibility among multiple implant systems Higher prevalence of rotational misfit Solutions to complications are found throughout the literature due to their extensive use Inadequate microbial seal IMPLANT PLATFORMS/CONNECTIONS Internal Connection Internal hex Morse Taper 8 point, 12 point contacts Tripod contacts Crossfit INTERNAL HEX CONNECTIONS ADVANTAGES AND DISADVANTAGES Advantages Less screw loosening Improved microbial seal Better joint strength More platform switching options Disadvantages There is less historical literature on internal connections than external connections compared to external hex Certain designs and diameters are weaker than others IMPLANT PLATFORMS The original Brånemark protocol required several externally hexed implants to restore fully edentulous arches, linking them together via a metal bar with a fixed prosthesis The external hex design was present to help screw the implant into place. In fact, for the fully edentulous, fixed prostheses abutments that were screwed down onto the implants, the hex was not engaged as an anti-rotation device IMPLANT PLATFORMS/CONNECTIONS Implant type/Internal connections Company dependent Straumann IMPLANT PLATFORMS/CONNECTIONS Implant type/Internal connections Company dependent Nobel Biocare COMPONENTS IMPLANT SUPPORTED CROWNS Two types of restorations Cement retained Screw retained NATURAL TEETH VS IMPLANTS NATURAL TEETH VS IMPLANTS FORCES APPLIED TO DENTAL IMPLANTS The internal stresses that develop in an implant system and surrounding biological tissues under imposed load may have a significant influence on the long term prognosis of the implants in vivo A goal of treatment planning should be to minimize and evenly distribute mechanical stress in the implant system and contiguous bone FACTORS AFFECTING LOAD BEARING CAPACITY OF IMPLANTS Implant surface Implant structure/material Quality of bone Type of load Shape and dimension of implant LOADS APPLIED TO IMPLANTS Mainly Vertical and Horizontal (lateral) Compressive: Tend to push masses towards each other Maintains integrity of bone – implant interface Accommodated best Cortical bone is strongest in compression LOADS APPLIED TO IMPLANTS Tensile: Pulls objects apart Shear: Sliding Distract / disrupt bone implant interface Shear forces are most destructive, cortical bone is weakest to accommodate shear forces SHAPE AND DIMENSION OF AN IMPLANT Currently available implants vary in diameter from 3 to 7 mm. Finite element studies (In vitro) suggest an implant with a wider diameter is more favorable in reducing the stress distribution in bone surrounding the implants Dental implants length commonly range from 8 to 15 mm. As the length of the surface area increases, it has been suggested that the stress level for a given applied load is reduced on longer implants because of greater surface area An increase in the implant diameter decreases the maximum value of Von Mises equivalent stress which occurs as a result of a more favorable distribution of the simulated average masticatory forces applied in this study influence of implant length and diameter on stress distribution: A finite element analysis, February 2004 Journal of Prosthetic Dentistry 91(1):20-5 SHAPE AND DIMENSION OF AN IMPLANT WIDER DIAMETER IMPLANTS Advantages Allows engagement of a maximal amount of bone Improved distribution of stress in the surrounding bone Allows for the application of higher torque in the placement of prosthetic components Disadvantages Limited by the width of the residual ridge Esthetic requirements for a natural emergence profile DOES IMPLANT LENGTH AND WIDTH MATTER FOR SHORT DENTAL IMPLANTS Ultrawide implants of ≥6 mm in diameter showed an excellent survival rate (98.28 %) and a very small amount of marginal bone loss. (Retrospective clinical study of ultrawide implants more than 6 mm in diameter, Jeong-Kui Ku et.al) From October of 1996 to December of 2004, 205 patients were operated on, and 304 WDIs were inserted. The mean postloading follow-up was 30 months. Implant diameter ranged from 5.0 to 6.5 mm with a survival rate of 98.4%. (Wide-diameter implants: analysis of clinical outcome of 304 fixtures, Degidi M) Griffin and Cheung reported on short, wide implants in posterior areas with reduced bone height for 168 HA-coated implants 6 mm in diameter and 8 mm long in 167 patients. The overall cumulative survival rate for up to 68 months (mean 34.9 months) after loading was 100%. Anner, et al in 2005 reported a 100% survival rate in 45 implants with a mean loading period of 2 years with a 6-mm-wide, tapered, HA-coated implant. Graves, et al in 1994 reported 96% survival over a 2-year period with 268 wide implants in 196 patients. DOES IMPLANT LENGTH AND WIDTH MATTER FOR SHORT DENTAL IMPLANTS From 1997 to 2011 13 studies looked at 1955 dental implants, 914 were short implants 377 implants were 6mm, 5 were 7mm, 349 were 8mm and 181 were 8.5 1041 were standard (10mm) Short dental implants had a survival rate of 88.% and standard implants had a survival rate of 86.7% over a 14 year period. FACTORS AFFECTING SUCCESS OF SHORT IMPLANTS Specific implant system used Implant surface topography Roughened surface vs Machined surface Implant maximized surface area Surgical protocol Type of prosthesis Single crown vs full arch prosthesis Splinting Occlusion vs cantilever Patient’s medical status IMPLANT #30 Student Melissa Morrison, DMD17 Faculty Pinelopi Pani DDS, CAGS, MS Hesham Nouh BDS, DSc, MSD, CAGS Neal Fleisher DMD, CAGS INTRAORAL PHOTOS SURGICAL PLAN GUIDE DESIGN GUIDE TRY-IN SURGERY POST-OP SURGERY PROVISIONAL RESTORATION