An Overview

of
Implantology
An Observation on Evidence Based
Medicine/Dentisry
What it is and What it isn’t?
Sackett DL BMJ1996
 The Transfer of Science into Practice
remains a Challenge
because Practitioners often face
Individual Patient Needs and Demands
that are not reflected in the required Rigors
of Randomized Controlled Clinical Trials
Goals of Implantology
 To accept for Treatment
a patient at any stage of
• Disease
• Atrophy
• or Trauma
 and with Health Permitting
restore the Patient to Normal
• Comfort
• Function
• Aesthetics and
• Health
 What is
Dental Implantology
?
The Use of Manmade Roots
to support Dentures
or
Crown and Bridgework
Implantology
is
Here to stay
 Implantology is
Preventive Dentistry
Other than the Presence of Natural
Teeth
The Presence of Implants
is the only way of Maintaining
Alveolar Bone
 After Tooth Loss
Implant Placement
is the Only Way
of Retaining Alveolar Bone
 Implantology
is One Modality
used in Restorative Dentistry
Implantology must be incorporated
into a Total Overall Treatment
Plan
Without the presence of Teeth
Bone resorbes away eventually
leaving the Basal Bone
Progress of Bone Loss
Progress of Bone Loss
Progress of Bone Loss
Progress of Bone Loss
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Progress of Bone Loss
Progress of Bone Loss
Progress of Bone Loss
Progress of Bone Loss
Progress of Bone Loss
Progress of Bone Loss
Progress of Bone Loss
Progress of Bone Loss
Implantology
is
Here to stay
 Implant may be
• In Mucosa (Intramucosal)
• On Bone (Subperiosteal)
• In Bone (Endosteal)
 Implant Surfaces
• Machine Finished
• Microetched
• Acid Etched
• Hydroxyapatite Coated
• Plasma Sprayed
 Implant Materials
• Pure Titanium
• Titanium Alloy
• Chrome Cobalt
• Stainless Steel
• Ceramics
Implant Treatment is determined by
• Patient Needs
• Anatomical Considerations
• Medical History
• Financial Considerations
 Implant Treatment is determined by
• The Competence of the Dentists
• The Standard of Implant Education
• The Enlightenment of the Public
Where does Implantology
fit into the Global Scene
of Dentistry ?
How many Implants are
placed
in the World ?
 1998
Estimate Number of
Implants placed
 UK
17,000
Spain
35,000
France
45,000
 Italy
150,000
Germany
220,000
Taiwan
150,000
 Implants sold in 2002
• USA 980,000
• Germany 150,000
• Taiwan 150,000
• Italy 110,000
 Implants sold in 2002
• France 100,000
• Scandinavia 60,000
• Spain 50,000
• UK 27,000
Efficiency of Lower Dentitions
All Natural Teeth ----------------100
Implant Borne Bridge ---------- 90
80
70
Implant Overdentures -------- 60
(tissue borne) 50
40
30
20
Complete Lower denture ------- 10
No teeth, no denture ------------- 0
 Requirements for
Comprehensive
Treatment Planning
 An Awareness of All
Treatment Methods
available for restoring Missing
Teeth
 An Understanding of
All the Implant Systems
required to provide
Comprehensive Treatment
No Implant System can be
used in All Circumstances
Implant Companies tend to
promote their own Products
Tatum Study
The Ridge Width
Measured in the
Lateral Incisor
Region
300 Upper
Edentulous
Ridges
More than 70%
were less than
3.5 mm Wide
A Deceptively Thin Ridge
Width Narrow
Expansion Instruments
Expansion Instruments
Implant placed
Restored Case
The Original Ridge
The Prepared Site
The Grafted Site
The Healed Site
Place Implants
6 or more
Months Later
Temporary Crowns
6 or more
Months Later
Final Crowns
6 or more
Months Later
Treatment of Inadequate
Vertical Ridge Height
Restore 6 Months
later
Block Bone Grafts are required
where Height is inadequate
Symphyseal Block Grafts
Block Grafts removed
Ramus Block Grafts
Ramus Block
Grafts
Block Grafts in place
Ridge Repositioning
Implant placed too far Palatally
Lower Incisors occluding
on the Implant Head
The Initial Incisions
Full Thickness Flaps elevated
Separating the Bone Block
using a Chisel
Repositioning the Block
The Bone Plate
Plate being Positioned
Bone Screw being placed
Irradiated Bone being added
Resorbable Membrane being placed
Resorbable Membrane being placed
Finished Treatment
Distraction Osteogenesis
Poor Ridge Height
Poor Ridge Height
The Distraction Devise in Place
Post-operative X-rays
Completion of Treatment
Completion of Treatment
Distraction Devise removed
3-4 Months later
Sinus Graft required
Maxillary
Sinus
outlined
 Maxillary
Sinus
Crest of
outlined
the Ridge
Grafted Sinus
The Restored Case
Place Implants 4 Months Later
Restore 6+ Months Later
Implants placed 6+ Months Later
Temporary Crowns placed
6+ Months
Soft Tissue Reconstruction
may be necessary
to create Attached Gingiva
Restore 1 Year Later
Width Good
 Width Good
Inclined Forwards
Angled Post fitted
 Ridge
Expand
Or remove the Sharp Ridge
The Sharp Ridge removed
The Implant placed
Narrow Ridge
Ridge Height Good
Implant placed
 above
the Canal
Wide Implant placed with Ridge Expansion
Narrow
Ridge
Blades
Blades in Place
Custom Blade in Place
Ralph and Harold Roberts
Ramus Blade in place
2-6 Months Later
 Restore 4 Months
after
Implant Placement
Gross Posterior Atrophy
Onlay Graft
Gross Posterior Atrophy
Onlay Graft
Place Implants
6 Months Later
 Restore
6 Months Later
Harold Roberts 1969
Severe Atrophy
Ramus Frame in Place
Temporary Denture
fitted immediately
Permanent Denture
3 Months Later
On Bone under the
Periosteum
Temporary Denture placed
Immediately
Permanent Denture 1 or more
Months Later
The Contribution of General
Practitioners to the
World of Implantology
• Blades
• Ramus Blades
• Ramus Frames
• Subperiosteal Implants
• Screw Implants
• Sinus Grafting
• Bone Grafting
• Nerve Lateralization
Dental Implants are the Most
Successful Implants placed
in the Body
Implants should be thought
of as a Lifetime Device
The Prosthetic Restorations
attached to the Implants
may need to be revised
at a Later Date
Due to Wear and Tear