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- 1. Dental Implant Treatment حمد رحمن عيسى عزاوي وعد عبدهللا عزاوي رعد عبيده
- 2. Introduction Implant Prosthodontics: It is the branch of implant dentistry concerning the restorative phase following implant placement and the overall treatment plan component before the placement of dental implants. It is the phase of prosthodontics concerning the replacement of missing teeth and/or associated structures by restorations that are attached to Dental Implants. Implant :-Any object or material, such as an alloplastic substance or other tissue, which is partially or completely inserted or grafted into the body for therapeutic, diagnostic, prosthetic or experimental purposes
- 3. Implant Classification Dental implant can be classifiedaccording to its on placement within tissue:- Subperiosteal: A CoCr casting custom made for an edentulous bony ridge and placed subperiosteally with integral trans-mucosal posts for denture retention. Transmandibular (transosseous) dental implants “staple boneplates”: The staple bone plate is used to rehabilitate the atrophic edentulousmandible. - It is a transosteal threaded posts which penetrate the full thickness of the mandible and pass into the oral cavity in the para symphysial area
- 4. Submucosal implants: A small “press stud- like” device within the soft tissue helping to retain a denture, usually maxillary denture Transdental fixation: A metal implant placed through a tooth and extended through the root canal into the periapical bone to stabilize the mobile tooth sometimes referred to as endodontic implants This was first used by Cuswell and Senia in 1983
- 5. Endosseous—blade (plate), ramus frame, transosteal or staple, root form, or cylindrical: These implants are anchored in bone and penetrate the oral mucosa to provide prosthetic anchorage. 1- Classification of endosseous implants according to their design: A- Cylinders endosseous implants. B- Screws or spiral post endosseous implants. C- Blade form endosseous implants. d- Root form endosseous implants
- 6. 2- Classification of endosseous implants according to their material: a- Pure titanium: the titanium oxide surface was responsible for the formation of the direct bone- implant interface. b- Titanium alloy: the titanium alloys exist in three forms: alpha, beta and alpha beta phases and they all originate when pure titanium is heated and mixed with aluminium and vanadium. 3- Classification of endosseous implants according to surface characteristics: A- Sand blasted surface. b- Titanium Plasma Sprayed surface (TPS), it has satisfactory results regarding the osseointegration and the clinical prognosis. c- Titanium oxide surface coating the implants to make the inert metal a bioactive one. d- Hydroxyapetite coating
- 7. 4- Classification of endosseous implants according to the insertion technique: The insertion techniques of endosseous implants have been classified into either: a- Press fit technique, in this type of unthreaded implants, the implant site is drilled slightly smaller than the actual implant size, where the implant is pressed into the recipient site with slight friction. B- Self tapping technique, in this type of threaded implants, the implant threads are used to tap its site during insertion. c- 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.
- 8. 5- Classification of endosseous implants according to surgical stages: A- Single stage design (none submerged – transgingival): the body of the implant is inserted into the bone with its abutment portion penetrating through the mucoperiosteum during the healing period. Surgical placement of a dental implant, which is left, exposed to the oral cavity following insertion. This is the protocol used in non-submerged implant systems b- Two stage design: in this design the implant body is completelyembedded in bone for complete osseointegration. The implant body is then exposed and the healing abutment is placed for soft tissue healing before the impression is made for prosthesis fabrication
- 9. 6.Classification of endosseous implants according to the time of installation: a- Immediate implants, they are placed into a prepared extraction socket following tooth extraction. B- Immediate delayed implants, they are placed within 6-12 weeks after the tooth loss. c- Delayed implants, they are placed within 6-12 months after tooth extraction, when complete healing and bone remodeling occur 7.Classification of endosseous implants according to time of prosthetic loading: a- Immediately loaded implants, an acrylic resin prosthesis which is designed to be out of occlusion is placed immediatelyafter implant placement, specially in anterior region for esthetic purposes. b- Delayed loading implant, delayed loading is done in maxillary implants after 4-6 months and in mandibularimplants after 3-4 months to allow for better osseointegration due to the difference of the investing bone composition
- 10. Factors Affecting Healing 1- Surgical Technique All surgical procedures are traumatic. The level of trauma is a critical factor that determines whether healing will progress toward fibrous or osseous integration. Surgical preparation on hard tissue causes a necrotic zone of bone (interface) due to cutting of blood vessels, frictional heat, and vibrational trauma.Excessive trauma leads to fibrous encapsulation of the implant.Surgicaltrauma must be minimized during all aspects of implant surgery to optimize success rates. The temperature for impaired bone regeneration has shown to be as low as 44 C to 47 C for one minute.
- 11. 2- Premature loading Time should be allowed for healing of necrotic bone, formed due to surgery. Movement of the implant during this healing phase will result in fibrous encapsulation. For this reason, it is recommended by many operators to keep the recently placed implants unloaded for a period of two to eight months depending on the clinical situation, implant coating, location of the implant, and whether the implant is placed into bone grafts. 3- Surgical fit Even with the best technical precautions, bone contacts only portions of the implant and a perfect microscopic contact is not possible. A longer healing period will be required before loading implants then surgical fit less then optimal
- 12. 4- Bone quality and quantity The mandible has a denser cortex and a coarser thicker cancelli than the maxilla. When we go posterior, jaws tend to have a thinner, more porous cortex, and a finer cancelli. Bone regeneration is more likely to progress at a faster rate if the surrounding is denser. it is very frequent to find that bone amount is not enough for implant placement.The following measures can be done to overcome this problem: - The use of short implants. - Changing the implant angulations. - Ridge augmentation. - Trans positioning of the neurovascular bundle in the mandible. - Subantral augmentation (sinus lift) in the maxilla. - Bone synthesis (ossified tissue can be created in predetermined shapes and dimensions). ب و س ي ش ن ن ك
- 13. 5- Physical condition of the patient: Nutritional status, aging, diabetes mellitus, blood diseases, corticosteroids therapy and radiation treatment are among many factors which can affect healing. Team Approach - Some authors believe that the same operator should place and restore the implants. The rationale is that it is more efficient form a patient's point of view. Italso allows the practitioner more freedom in changing the predetermined position of the implants at the time of surgery. Because the same individual is responsible for the prosthetic treatment, these changes can be incorporated into the treatment plan more readily. - Others believe that a team approach is more appropriate to follow. A surgeon should place the implants, and a prosthetic dentist should complete the restoration.Because it allows for the utilization of expertise of the two individuals, there is a built- in second opinion in the approach. Additionally, there is shared responsibility and shared liability. Regardless of the philosophy followed, it is well to delineate the responsibilities at each stage of implant therapy, and it should be clear that dental implant is a prosthetic technique with a surgical step.
- 14. The prosthodontist should: 1- Perform the initial clinical evaluation. 2- Perform the initial radiographic evaluation. 3- Obtain the diagnostic casts. 4- Obtain the diagnostic wax- up. 5- Determine the location and number of implants and fabricate a surgical template. 6- Select the proper abutment following the implant exposure. 7- Design and fabricate the prosthesis. 8- Provide oral hygiene care and instructions. 9- Ensure recall of the patient to evaluate maintenance and provide care as required.
- 15. The oral surgeon responsibilities include: 1- Confirmation of the radiographic evaluation. 2- Confirmation of the physical evaluation. 3- Determination of the location and number of implants within limits set by the prosthetic dentist. 4- Placement of the implants (first stage surgery). 5- Uncovering of the implants (second stage surgery). 6- Confirmation of osseo-integration of the implants. س ي ر ج ن
- 16. Components of Brainmark Implant System: I. Implant Fixture/Implant BodyThe portion of a dental implant that provides support for the abutment(s) through adaptation upon (eposteal), within (endosteal) or through (transosteal) the bone . The body is that portion of the implant designed to be surgically placed into the bone. It may extend slightly above the crest of the ridge.
- 17. II. Healing/Cover Screw The component of an endosteal dental implant system used to seal, usually on an interim basis, the dental implant body during the healing phase after surgical placement. The purpose of the healing screw is to maintain patency of the internal threaded section for subsequent attachment of the abutment during the second stage surgery.
- 18. III. Healing Abutment/Interim Endosteal Dental Implant AbutmentAny dental implant abutment used for a limited time to assist in healing or modification of the adjacent tissues .After a prescribed healing period that allows a supporting interface to develop, second stage surgery is performed to uncover or expose the implant and attach the transepithelial portion or abutment. This transepithelial portion is termed a second stage permucosal extension, because it extends the implant above the soft tissue and results in the development of a permucosal seal around the implant.
- 19. IV. Implant Abutment The portion of a dental implant that serves to support and/or retain any prosthesis . Three main categories of implant abutments are described according to the method by which the prosthesis or superstructure is retained to the abutment: (i) an abutment for screw uses a screw to retain the prosthesis or superstructure; (ii) an abutment for cement uses dental cement to retain the prosthesis or superstructure; (iii) an abutment for attachment uses an attachment device to retain the removable prosthesis.Many manufacturers classify abutments as fixed whenever cement retains the prosthesis and removable when they are screw retained. Each of the three types of abutments is further classified into straight and angled abutments, describing the axial relationship between the implant body and abutment.
- 20. V. Hygiene ScrewIt is placed over the abutment between prosthetic appointments to prevent debris and calculus from entering the internally threaded portion of the implant. VI. Transfer Coping/Impression Coping Any device that registers the position of the dental implant body or dental implant abutment relative to adjacent structures.
- 21. VII. Implant Analog An analog is something that is analogous or similarto something else. Implant analog is used in the fabrication of the master cast to replicate the retentive portion of the implant body or abutment. After the master impression is secured the corresponding analog (implant body, abutment for screw or other portion) is attached to the transfer coping and the assemblyis poured in stone to fabricate the master cast. VIII. Coping/Gold Cylinder It is a thin covering usually designed to fit the implant abutment and serve as the connection between the abutment and the prosthesis or superstructure. A prefabricated coping usually is a plastic pattern cast into the metal superstructure or prosthesis.
- 22. IX. Coping Screw The screw retained prosthesis or superstructure is secured to the implant body or abutment with a coping screw.
- 23. Thank you