OVERVIEW OF DENTAL

IMPLANTOLOGY
Dr. Deborah M. Ajayi
Consultant Restorative Dentistry,

Implantology is the science of

implanting foreign (alloplastic) materials
to replace endogenous (lost) organ
functions with the objective of tissuefriendly setting (biointegration).

A Dental Implant is a device inserted

into or on the jaw bone to anchor an
artificial tooth or denture (prosthesis).

A root analog.

Mayan civilization first used the earliest known

endosseous implant over 1400 years ago.
In 1931, Archaeologists from Honduras confirmed it.
In 1950, Researchers at Cambridge University implanted a
chamber of titanium in rabbits ear.
In 1952, Swedish Orthopaedic Surgeon I-P Branemark
implanted titanium rabbit femur.
In 1952, Dr. Leonard Linkow at the New York University
College of Dentistry placed his first dental implant.
In 1965, Branemark placed his 1 st titanium dental implant.
1960s Sub-periosteal implants introduced.
1970s Blade implants was in vogue.

1.

Mucosal Insert

2.

Endodontic Implant (Stabilizer)

3.

Transosseous implant

4.

Sub-periosteal implant

5.

Endosteal or Endosseous implant

Endodontic implants
are similar to
prosthodontic implants
in many respects.

However, they serve

another purposethe
stabilization and
preservation of
remaining natural teeth,
not the replacement of
lost teeth.

Placed through the

mandible (only)

Attachments reside
above ridge
Rarely used

rests on alveolar
ridge, no bone
invasion

Less invasive,

less stable
Supports denture

3 types; plate/blade
form, ramus frame and
the root form-(Most
common)
Placed in the bone
Single tooth or multiple
teeth replacement
Screwed or non screwed
Cylindrical or tapered
Surface treatment

Grit blasting, plasma

sprayed etc

Prof Branemark
Root form
implants
Improved the
designs &
techniques
Reports of success
rates from over
15 years
experience.
Improved
understanding

A direct structural and functional connection between

ordered living bone and the surface of a treated implant,
which is visible under the light-optical microscope.
(Branemark 1952)

A time-dependant healing process where by clinically

asymptomatic rigid fixation of alloplastic materials is
achieved, and maintained, in bone during functional loading.
(Zarb & Albrektson,1991)

Relies on an understanding of

Tissue healing and repair

Tissue remodelling
Effects of force in all vectors
Immune response to the insertion of foreign bodies.

1.
2.
3.
4.
5.
6.

Implant biocompatibility
Implant design
Implant surface
Implant bed
Surgical technique
Loading condition

Similar soft tissue relationship to natural

dentition(sulcular epithelium)
Hemidesmosome like structures connect
epithelium to titanium surface
Circumferential and perpendicular
connective tissue
No connective tissue insertion
No intervening sharpey fiber attachment

Osteoblast is in close proximity to

interface
Separated from implant by thin
amorphous proteoglycan layer
Oxide layer continues to grow- mineral
ion interaction
Increase in trabecular pattern
Bone deposition and remodeling in
response to stress.

Usually a metal or alloy which must be

biocompatible, strong and lightweight.
Most commonly used
Commercially pure titanium (CP titanium)
Lightweight, Biocompatible,Corrosion resistant,
Strong and low priced
Titanium-aluminum-vanadium alloy (Ti-6Al4V)- stronger and used with smaller diameter
implants
Zirconium
Hydroxyapatite (HA), one type of calcium
phosphate ceramic material

ADVANTAGES OF DENTAL IMPLANT

No preparation of adjacent
teeth.
Bone stabilization and
maintenance
Retrievability
Improvement of function
Psychological improvement
May be fixed or removable.
High level of predictability.
It can last for a life time.

DISADVANTAGES OF DENTAL
IMPLANT.

Involves elective surgery.

High operator/technique
dependent.
High initial expense.
Lengthy treatment time.
Requires some moderate
maintenance.
Depends on the availability
of adequate bone quantity
and quality.
Challenging aesthetic

INDICATIONS OF DENTAL IMPLANTS

Good general health

Adequate bone quality and
volume
Appropriate occlusion and
jaw relations
Inability to wear
conventional prosthesis
Unfavourable
number/location of
abutment
Single tooth loss

CONTRAINDICATIONS

Unrealistic patient expectations

Alcohol/drug dependence and
smoking
Parafunctional habits
Psychological factors
Inadequate ridge/inter-arch
dimensions
Immunosuppression
Diabetes (Uncontrolled)
Coronary artery Disease
Drug therapy: e.g Anticoagulants
Osteoporosis

Replacement of lost tooth teeth due to :

Trauma,(Avulsed tooth, fractured tooth,etc)

Dental disease (gross caries, endodontic failures,
periodontitis etc)
or developmental abnormalities(congenitally missing
tooth,).

To overcome problems of free end saddle

Anchorage for orthodontic tooth
Single tooth replacement
Fixed multiple tooth loss- Implant
retained bridge prosthesis
Completely edentulous patients implant
retained removable dentures.

Patient Education.

Treatment options
Multidisciplinary approach.
Long-term commitment
Surgical and Restorative procedures
Maintenance and regular recall

Fee and payment policy

The inform consent.

General Health :

History : Dental, Medical, Social and Habit

Examination ;
Laboratory investigations

Predictable risks

Teeth
Periodontium
Radiographic analysis
Surgical analysis
Aesthetic analysis
Occlusal analysis

Number and existing condition:

Minimum 6-7mm between teeth to facilitate

implant placement
>1.5mm between implant and natural teeth
7mm from centre of implant to centre of
implant for edentulous
More than 10mm mesiodistal space- single
tooth implant not recommended

Prognosis of remaining teeth

Tooth and root angulations and proximity
Mesiodistal width of the edentulous space

According to Lekholm and Zarb.,1985 classified bone

quality as:
Type I
Composed of homogenous compact bone, usually found in the
anterior mandible

Type II
A thick layer of cortical bone surrounding dense trabecular bone,
usually found in the posterior mandible

Quality III
A thin layer of cortical bone surrounding dense trabecular bone,
normally found in the anterior maxilla but can also be seen in the
posterior mandible and the posterior maxilla.

Quality IV
A very thin layer of cortical bone surrounding a core of low-density
trabecular bone, It is very soft bone and normally found in the
posterior maxilla. It can also be seen in the anterior maxilla .

6mm or below buccal-lingual width with

sufficient tissue volume.
8mm interradicular bone width
10mm alveolar bone above IAN canal
or below maxillary sinus

There is need for sufficient tissue

volume to create gingival papilla
Need some attached gingiva to
maintain peri-implant sulcus
The implant is placed 2-3mm apical to
free gingival margin of adjacent
tooth/teeth.

Radiographs : periapical, occlusal, panoramic

and CT scan or tomograph as indicated.
CT gives more accurate and reliable
assessment of bone
Assess

Periapical pathology
Adequate vertical bone height
Adequate space above IAN or below the maxillary
sinus
Adequate interradicular area
Bone quality and quantity

Smile line
Lip shape
Existing ridge
Restored implant
should appear to
emerge from the
gingiva
Produce a natural
and desirable
appearance

Assess for
parafunctional habit:

tooth lost to occlusal

trauma or
parafunctional habit is
less successful with
implant

Diagnostic cast is
produced and
mounted to
determine opposing
occlusion

Implant surgery

Placement of Implant

Single stage
Two stages
Immediate
Standard
Delayed

Implant loading

Immediate
Delayed

Pre-operative medication
Local Anaesthetic with or without
general sedation
Analgesics, such as ibuprofen or
paracetamol
can
be
administered
immediately prior to surgery.
Sterile
environment
should
be
maintained throughout the surgery.
Chlorhexidine 0.2% is used as a preoperative
mouthwash
and
skin
preparation.

A mid-crestal incision with vertical

relieving incisions (if closed to adjacent
teeth including inter-dental papilla).

A mucoperiosteal flap is raised.

The
flaps
should
be
elevated
sufficiently far apically to reveal any
bone concavities, especially at sites
where perforation might occur.

EDENTULOUS JAW FOR IMPLANT

MARKINGS FOR INCISION

MID CRESTAL INCISION MUCOPERIOSTEAL FLAP

It is essential not to allow the bone to be

heated above 47C during preparation of
the site as this will cause bone cell death
and prevent osseointegration.

This problem may be avoided by:

Using sharp drills

Incremental drilling procedure

increasing diameter drills

Avoidance of excessive speed

Using copious
irrigation.

sterile

normal

with

saline

Preparation
commence
with
Initial penetration.
Pilot drill

guide pin is placed to

check the direction

Check the final depth

with a depth gauge

Check the spacing and angulation of

the implant sites carefully with
direction indicators throughout the
drilling sequence

Angulations of the implants should be

consistent with the design of the
restorations

Implant should be placed such that;

It is within bone along its entire length.

It does not damage adjacent structures such as
teeth, nerves, nasal or sinus cavities.

Multiple implants sholud be placed in fairly

parallel arrangement.

The top of implant should be placed

sufficiently under the mucosa to allow a good
emergence profile( eg 2-3mm apical to labial
CEJ of adj. Teeth)

Buccal plate surface

0.5 mm.

Lingual plate surface

1.0mm

Maxillary sinus

1.0mm

Incisive canal

avoid midline of maxilla

Nasal cavity

1.0mm

Inferior alveolar canal

2. 0 mm. From superior aspect of

the canal

Mental nerve

5. 0 mm from anterior of the bony

foramen.

Adjacent natural tooth

0.5 mm

Between 2 implants

3.0 mm

The implant is supplied

in a sterile container,
either already
mounted on a special
adapter or unmounted
necessitating the use
of an adapter from the
implant surgical kit.

In either case the

implant should not
touch anything before
its delivery to the
prepared bone site.

Cylindrical
implants
are either pushed or
gently knocked into
place.

Screw shaped implants

are either self tapped
into the prepared site
or inserted following
tapping of the bone
with a screw tap.

The mucoperiosteal
flaps are carefully
closed with multiple
sutures either to bury
the implant completely
or around the neck of
the implant in nonsubmerged systems.

Silk sutures are

satisfactory and others
such resorbables are
good alternatives.

Take Postoperative
radiographs(Periapi
cals) to evaluate
implant position in
relation to adjacent
structures.

Also for monitoring

the
ossteointegration.

Haemostasis
Medications

Dalacin C 300mg 12hourly for 5 days

Tab vitamin C 1g daily for 2weeks
IM Paracetamol 600mg stat
Tabs Diclofenac 50mg 12hourly for 3days

Ice packs to reduce swelling and

pain
chlorhexidine 0.2% mouthwash
Avoid smoking and alcohol.

Intra operative:

Tear of flap.
Insufficient irrigation thermal injury to
bone.
Perforation of buccal or lingual cortex
Impingement on inferior dent canal/ nerve.
Impingement on adjacent tooth.
Perforation of maxillary sinus,
Lack of primary stability.
Fracture of implant.

Immediate post-op:

Pain ( rare)
Haemorrhage( also rare)
Swelling
Nerve injuries.

Delayed:

Infection
Secondary Haemorrhage.
Nerve injury.
Loosening of implant & Loss of implant

Anatomical
Neurological
Deintegration
Progressive thread exposure
Gingivitis
Hyperplastic tissue
Fractured Implant

Exposure of implant
with minimal flap
reflection.
Removal of the
cover screw.

2) Custom
fabricated Abutment

3) CAD/CAM fabricated

Wax up of the
superstructure
Fabricate the
framework
Venering(porcelain
baking)

The completed, metal-ceramic

superstructures

According to Harvard success Criteria for

Dental implant, Dental implant must provide
functional service for 5 years in 75% of cases.
Criteria are both subjective and objective.
Subjective Criteria
Adequate function
Absence of discomfort
Improved aesthetics
Improved emotional and psychological
wellbeing

Bone loss no longer than 33% of vertical length of

implant
No peri-implantitis
No associated radiographic radiolucency
Marginal bone loss 1.0-1.5mm first year; then <
0.1mm annually thereafter
Good occlusal balance and vertical dimension
Gingival inflammation amendable to Rx
Mobility of less than 1mm in all direction
Absence of symptoms of infection
Absence of damage to surrounding structure
Healthy connective tissues

Primary goal is to protect and maintain tissue-integration;good oral

hygiene is a key element!
Implant patients should be thoroughly instructed in maintenance therapy
with the understanding that the patient serves as co-therapist
Home-care regimen periodic recalls reinforcing regimen
strict adherence to recall schedule & verification of function, comfort, and
aesthetics.

immediate post-delivery

24 hours

one week

one month

6 months

bi-annual or annual evaluation

lifetime maintenance commitment

Dental implant is one of the defining

advances in clinical Dentistry.

Therefore every Dentist should key into

the current trend in implantology and
use such to improved the patient well
being and psychosocial life of patients.

Thank you for your

attention.

Stuart H. Jacobs and Brian C. OConnell Dental Implant

Restoration Principles and Procedures 2011. Quintessence
publisher.
John A. Hobkirk, Roger M. Watson and Lloyd J.J Searson
introducing Dental Implant 2003. Churchhill livingstone Publisher.
Ivoclar Vivadent Competence in Implant Esthetics, Manual of
Implant Superstructures for Crown and Bridge Restorations. 2010
Pennwell dental Group
Albrektsson el ta The longtime efficacy of current Used Dental
Implant: A review and Proposed Criteria of success. 1997
Sanjay CHAUHAN, Dental Implant Surgery, Rewari 1999

Abd El Salam El Askary Reconstructive Aesthetic

Implant Surgery. 2003 Blackwell Publisher.