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Dental Implants History and Definition

material alloplastic is a device made of Dental Implant
(inert material that does not react with the body tissues)
usually its titanium; implanted in the oral tissues under
mucosa and periosteum or within bone to provide
retention and support for a fixed or removable prosthesis.


stones in implants are: foundation The

; or tooth not a root are s mplant I - 1
implant is not analogues to the root or
tooth , it's just a device for a final
prosthesis. If a patient has three missing
teeth we put two implants and a bridge ,
not three implants so not every missing
tooth should be replaced by implant and
not every missing root should be replaced
by implants, for example we place one
implant for upper missing six with three
roots.

- At the beginning of implants for all missing teeth they were put an
implant for every tooth then they became 12 then 10 then 8 but
nowadays there is a concept called (All In Four); four implants per
arch.
; not all patients with implant have not always fixed are s mplant I - 2
fixed restoration, some implants are supported with denture called
made s implant , and there are denture partial implant supported over
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over hybrid which is something can be inserted and removed by the
patient.
removable or or So the restoration on implants can be fixed -
. ion between fixed and removable combinat
; ast predictable treatment plan sometimes implants are the le - 3
in some cases it's not esthetically to go for implants especially with
two adjacent implants with soft tissue loss and bone loss.
8 missing patient with ; We dont replace every missing tooth - 4
doesn't need implant , and a patient with missing 7 since 10 years
esthetically and functionally no need to go for implant unless he
come with fresh extraction and hes afraid of drifting or supra-
eruption or he doesn't like the space and keep complaining about it .

- This is a picture for an (implant
supported crown or restoration) or
(implant retained crown or restoration)
shows the difference between the
implant and natural tooth, in which the
natural tooth is a calcified tissue with
crown, root and PDL while the implant
is a fixture ankylosed device , (means no
fibrous tissue between implant and
bone, if there is a fibrous tissue there
will be lack of osseointegration which is failure).

-this is called endooseous implant which has
different shapes; threads, micro threads, parallel
sided, screws, tapered, hollow, solid,
-There is another part of implant which is the abutment, it's always
screw retained, the screw to tighten the abutment to the implant .
And the final restoration which is the crown.

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History Of Dental Implants
Maya civilization which is in south America worked with
endosseous implant 1350 years before per-ingvar branemark )
implant inventor) work with titanium.
Archeologists excavated Maya burial sites Honduras in 1931 and
found fragments of mandible of Maya origin and they thought that
she is a female, dating from about 600 AD. They found three shells
in a tooth shape in anterior mandible were osseointegrated with
the compact bone that means this female has these shells in her
mandible before her death, because no way of osseointegration
after death.
1950s research at Cambridge University in England: titanium
chamber was embedded in the soft tissue of the ears of rabbits.
1952 Swedish orthopedic surgeon per-ingvar branemark:
titanium chambers in rabbit femurs, after several months he was
unable to remove them that mean there is osseointegration
between them.
1965: branemark placed the first dental implant into a human
volunteer, and he made a surprise that his patients used
prosthesis supported by implant in anterior mandible 15 years
ago without telling anybody.
Implant is documented in the worldwide in 1977 and started to be
one of the options.
: Types Of Dental Implants
Endosteal: it could be screws either cylindrical or threaded
tapered most commonly used , or in some cases plates or
blades least commonly.

Subperiosteal; elevating a flap then putting titanium piece like
plate subperiosteal then bone will be formed over this piece .
useful in reduced bone volume . They are not common such as
endosteal because of their high failure rate .

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-Implants have different sizes and diameter but in
general they are classified into narrow (3.5mm),
regular (4mm) and wide (5mm).

options: Treatment
1- No treatment (missing 8, for example).
2- RPD
3- FPD (bridge)
4- Complete denture
5- Implant supported prosthesis


Restoration of implants:
Direct to fixture or Direct to implant:
simply the restoration is connected to
the implant by screw, used when the
implant is in the proper position without
deviation .







Angulated or tilted implant in which we can't
put the restoration directly over it So we use
an abutment to change the angulation
by screwing the abutment in the implant to
achieve proper restorative contours then attach
the final restoration to the abutment either by
screw (vertical screws like occlusal screws or
horizontal screws like transverse or cross-pin
screws) or you cement it.


Ideally placed implant
Poorly placed implant
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Why titanium is the best material of choice?

Titanium is a natural cheap base metal in which very minimal oxide
layer composed above it. To get strong osseointegration there are
two Features : presence of oxide layer, have minimal thick layer in
which titanium has minimal thick oxide layer so it has best
osseointegration

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Now lets talk about some cases ,

A case for an implant in a proper position to restore right central
incisor, the final restoration will be just one piece without
abutment so called direct to fixture.

of implant we use a improper position In cases of
. restoration with an abutment

A case for 24 years old male had bike accident, he lost central,
lateral and canine with dentoalveolar fracture , So bone graft was
done first then three implants were placed, two of them were in
proper position so the final restoration placed directly to the
implant without abutment, and the other implant was in improper
position in this case we need abutment by screwing it in the
implant then attach the final restoration to the abutment.

A case for African patient who his lower centrals and canines were
extracted as a tradition ,two implants were used to replace the
missing teeth .
anterior mandible is one of the best locations for dental
implants because it has such good compact bone.





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In a case of a patient has unstable denture due to bone
resorption we put two implants in the lower arch and 2-4 in
the upper and an attachment so it's called denture supported
implant.
The denture will be clicked on locators
in the mouth instead of depending on saliva and cohesion.



- Nowadays implants are
done without elevating flap,
they use the computer to
convert a CT scan to 3D view
which allows us to visualize
anatomy then selecting the
location of implants
according to surgical guides,
the implant frame becomes
ready according to operator
guidance, and the final
restoration is made using the computer .


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Done by :
Rawan Shatnawi & Rasha Al-Shboul