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Disclaimer
This presentation is reprinted by Cigna with the permission of its author, Dr. Thomas Taylor. The health information in this presentation is provided by Cigna solely for informational purposes as a public service to promote health. It does not constitute medical advice and is not intended to be a substitute for your professional judgment. Neither Cigna, nor the author of the materials, nor the author's institution assume any responsibility for any circumstances arising out of the use, misuse, interpretation or application of any information supplied in this presentation or on this website.
Dental Implants:Past and Present
Thomas D.Taylor, D.D.S., M.S.D.
UConn School of Dental Medicine
Effective December, 2011 – December, 2016
Objectives
During this program, you’ll gain an understanding of:
Tooth loss and its consequences The evolution of today’s dental implant The importance of osseointegration and the factors that
influence it The steps involved in the dental implant process Some of the many applications of dental implant
therapy
Then and Now: A Brief History of the Evolution of the Dental Implant
Tooth Loss can result from a variety of factors including:Disease
Periodontal disease Dental caries
Trauma Failure to develop
Then and Now: A Brief History of the Evolution of the Dental Implant
“Statistics show that 69% of adults ages 35 to 44 have lost at least one permanent tooth to an accident, gum disease, a failed root canal or tooth decay. Furthermore, by age 74, 26% of adults have lost all of their permanent teeth.”- American Association of Oral and Maxillofacial Surgeons
Then and Now: A Brief History of the Evolution of the Dental Implant
Consequences of tooth lossNutritionalPsychosocialEstheticPhysiological
Physiological consequences of tooth loss
A healthy tooth root transfers biting forces to supporting bone and maintains its strength and integrity.
When a tooth is lost, there are no longer any forces being transferred. The bone may then begin to atrophy.
Adjacent teeth can begin to migrate causing additional
gaps and an unsightly appearance.
Then and Now: A Brief History of the Evolution of the Dental Implant
Then and Now: A Brief History of the Evolution of the Dental Implant
Physiological Consequences of tooth loss Changes in Intraoral Structure
Some remaining alveolar ridge Very little remaining alveolar ridge
Then and Now: A Brief History of the Evolution of the Dental Implant
Traditional Solutions for Tooth loss include: Fixed partial dentures Removable complete or partial dentures
Then and Now: A Brief History of the Evolution of the Dental Implant
Fixed partial dentures can lead toNegative effects on adjacent healthy teethRecurrent cariesPeriodontal disease
Then and Now: A Brief History of the Evolution of the Dental Implant
DENTURES
Then and Now: A Brief History of the Evolution of the Dental Implant
At best 17% as efficient as real teeth!At best 17% as efficient as real teeth!
Then and Now: A Brief History of the Evolution of the Dental Implant
Surgical Attempts to improve the denture bearing foundation have included:
VestibuloplastyVestibuloplasty OsteotomyOsteotomy ImplantologyImplantology
Then and Now: A Brief History of the Evolution of the Dental Implant
Soft tissue surgery- vestibuloplasty
Then and Now: A Brief History of the Evolution of the Dental Implant
Hard tissue surgery- osteotomy
1 month post surgery 6 months post surgery 1 year post surgery
Then and Now: A Brief History of the Evolution of the Dental Implant
Immediately after osteotomy One year after osteotomy
Then and Now: A Brief History of the Evolution of the Dental Implant
Dental ImplantsDental Implants Until 1982 limited to Until 1982 limited to
anecdote and empiricismanecdote and empiricism Premature clinical use and Premature clinical use and
poor documentationpoor documentation Lack of clinical trialsLack of clinical trials Lack of longitudinal resultsLack of longitudinal results
1909 radiograph of iridium basket implantused to replace one tooth
Archeological evidence of dental implants using whale bone or ivory From Central America
Then and Now: A Brief History of the Evolution of the Dental Implant
Traditional dental implants can be divided into several main types, and they can be described according to their shape and how they are attached to the jaw.
ENDOSSEOUS IMPLANT (within the bone) SUBPERIOSTEAL IMPLANT (on top of the bone) TRANSOSTEAL IMPLANT (through the bone)
Then and Now: A Brief History of the Evolution of the Dental Implant
ENDOSSEOUS IMPLANT “within the bone”
blade-shaped implants
Epithelial down growth over time with blade implants
Blade Implant
Then and Now: A Brief History of the Evolution of the Dental Implant
BLADE IMPLANT FAILURE
Alveolar bone
Scar tissue
Dental implant
Then and Now: A Brief History of the Evolution of the Dental Implant
SUBPERIOSTEAL IMPLANTS -“on top of the bone”These implants consist of a metal framework that rests on top of the jawbone but underneath the gum tissue.
Then and Now: A Brief History of the Evolution of the Dental Implant
Posts remain above the gum tissue as anchors for a prosthesis
Metal framework lies on top of the mandible Subperiosteal
Implants
Then and Now: A Brief History of the Evolution of the Dental Implant
Subperiosteal Implant Failure
Down growth ofepithelium and exposure of the implant
Then and Now: A Brief History of the Evolution of the Dental Implant
STAPLE OR TRANSMANDIBULAR IMPLANTS (TMI) IMPLANTS
TRANSOSTEAL IMPLANTS “through the bone”These implants are either a metal pin or a U-shaped frame that passes through the jawbone and the gum tissue, into
the mouth.
Then and Now: A Brief History of the Evolution of the Dental Implant
Radiographic and intraoral views of a transmandibular staple implant
Then and Now: A Brief History of the Evolution of the Dental Implant
THE MODERN ERA OF DENTAL THE MODERN ERA OF DENTAL IMPLANTOLOGY BEGAN IN 1982 AT A IMPLANTOLOGY BEGAN IN 1982 AT A
CONFERENCE IN TORONTOCONFERENCE IN TORONTO
Then and Now: A Brief History of the Evolution of the Dental Implant
Per Ingvar BrPer Ingvar Brånemark, MD, PhDånemark, MD, PhD
Professor of OrthopedicsProfessor of OrthopedicsUniversity of GothenburgUniversity of Gothenburg
Then and Now: A Brief History of the Evolution of the Dental Implant
Radiograph of one of the first human titanium implants placed in 1965
Titanium dental implant in the jaw of a dog
Then and Now: A Brief History of the Evolution of the Dental Implant
OSSEOINTEGRATION Direct contact, at the light microscopic level, between the implant Direct contact, at the light microscopic level, between the implant
surface and vital bone in a functionally loaded implant. Also surface and vital bone in a functionally loaded implant. Also called “functional ankylosis” (Schroeder).called “functional ankylosis” (Schroeder).
Alveolar bone
Implant
Direct contact at the lightmicroscopic level
Then and Now: A Brief History of the Evolution of the Dental Implant
Titanium Highly corrosion resistant Lightweight metal Conducive to osseointegration
Then and Now: A Brief History of the Evolution of the Dental Implant
Then and Now: A Brief History of the Evolution of the Dental Implant
Tooth root replacement
Bone forms a bond with the dental implant
• The implant functions like a natural tooth and is biocompatible
• The implant fuses to bone – should be permanent
• The implant is resistant to infection (periodontal disease)
• Implants are usually shaped like a screw or cylinder and are made either of metal, metal covered with ceramic, or ceramic material.
What factors influence implant Osseointegration?
Implant design Host site Surgical technique
Implant Design
Implant diameter The diameter of most implants falls
within the range of 3.25 to 6 mm. Larger diameter implants may be
used in posterior areas of the mouth and where there is poor bone quality.
Implant length Research shows that various
lengths of implants can be used ranging from 6 to 15 mm.
It’s good practice to use the longest implant that can be safely placed.
Implant Design
Abutments are divided into two types Prefabricated abutments
These are made by the manufacturer of the implant and can be modified by the restorative dentist as needed.
Custom abutments These are fabricated by a dental lab using CAD/CAM technology similar to that
used for crowns and are made for a specific patient.
ABUTMENT: The component that connects the final prosthesis to the implant
Implant Design
PorcelainFused to Metal
Crown
AbutmentScrew
The Host SiteWho is a good candidate?
Overall the patient must: Have a comprehensive evaluation Be in good health Have healthy oral tissues Have adequate bone structure Demonstrate a willingness to
practice home care Maintain regular dental visits
Almost anyone can have dental implant surgery
Areas of concern that affect wound healing:
Tobacco use Uncontrolled diabetes Radiation therapy Ability to take care of the implants Overall health sufficient to
undergo minor elective surgery
Surgical Technique Surgical Experience Operating conditions Drilling technique
Healing and loading times Delayed loading – 6-8 weeks post surgery Early loading – 4-6 weeks post surgery Immediate loading – day of surgery-one week post surgery Avoid loading the implant during the 2-4 week period post-
surgery (transition period between primary and secondary stability)
What are the risks and benefits?
BENEFITS Dental implants can replace
teeth without involving adjacent natural teeth
Dental implants help prevent bone resorption
Dental implants eliminate the problem of ill-fitting dentures and subsequent irritation
Clinically proven success rate of over 90%
Implants look natural and healthy
RISKS Bleeding Infection Failure to osseointegrate
(very rare)
Who Should Place Implants?
Implant treatment may be provided in several ways:
Implants can be placed by a team of dental professionals. This might include an oral surgeon or a periodontist who performs the surgical procedures, and a prosthodontist or a general dentist who fabricates the prosthesis over the implant. Prosthodontists now receive training in the placement of implants during their residency.
A dentist who has had extensive dental implant and associated training and limits his or her practice to implants may perform both the surgery and fabricate the prosthesis over the implant
A general dentist possessing the required knowledge, skills, and training may include implant procedures in his or her practice and perform all the procedures.
A team approach to treatment is generally preferred for more complex implant cases.
Types of Prostheses over Implants
Partially Edentulous Cases Restored with single crown or fixed partial denture
restorations Cemented or Screw retained design Porcelain fused to metal
Completely Edentulous Cases Restored with fixed or removable restorations
Fixed Porcelain fused to metal bridge design Hybrid design
Removable Similar design to traditional dentures except containing
attachments to supporting implants
What is the dental implant process?
There are generally four steps involved in the dental implant process that take several months to complete Careful planning Surgical placement of the implant body
Followed by 6-8 weeks of healing and osseointegration
Attachment of the abutment (if used) Placement of the final restoration
Step 1: Careful Planning
• Careful assessment of the patients oral and overall health• Address any patient questions and concerns• Radiographs• Diagnostic casts • Other tests
Step 2: Surgical Placement of Implant
Step 2: Surgical Placement of Implant
Single Implant placementThe dentures of an edentulous patient can be lined with a soft material and placed back in patient’s mouth after implants are placed.
Step 2: Surgical Placement of Implant
Healing cap
Step 3: Attachment of Abutment
Abutment
Step 3: Attachment of Abutment
Step 4: Placement of Restoration
Crown Restoration
Step 4: Placement of Restoration
Aftercare
Other Applications: Fixed Partial Denture
Other Applications: Fixed Partial Denture
Other Applications: Fixed Partial Denture
Other Applications: Implant Supported Overdenture
O-Ring or Stud Retained OverdentureAnd
Bar-Clip Type Overdenture
Other Applications: Implant Supported Overdenture
Initial placement
After healing
Non-splinted implantswill support an overdenture
Other Applications: Implant Supported Overdenture
Removal of the healing caps reveals the implant bodies
Ball-shaped attachments (abutments)
Other Applications: Implant Supported Overdenture
Other Applications: Implant Supported Overdenture
Impressions are taken to properly fit the overdenture
Other Applications: Implant Supported Overdenture
Stud recipient sites
Other Applications: Implant Supported Overdenture
Other Applications: Fixed Denture
Other Applications: Fixed Denture
Abutment posts
Small spaces allow for cleaning the prosthesis and abutment posts
Hybrid design
Other Applications: Fixed Denture
Other Applications: Fixed Prostheses
Radiograph and intraoral images of a patient with a failing maxillary fixed restoration and removable partial denture.
Other Applications: Fixed Prostheses
Surgically placed implants in the maxilla and mandible
Other Applications: Fixed Prostheses
4 anterior and 4 posterior implants were placed in the maxilla
4 posterior implants were placed in the mandible
Other Applications: Fixed Prostheses
Impression copings were used to make the master impression A temporary bridge was also used during the healing process
Impression copings
Temporary bridge
Other Applications: Fixed Prostheses
An implant level Impression was made of the maxillary arch. Implant replicas were then attached to the impression copings A stone cast was then made from the impression.
Other Applications: Fixed Prostheses
The master working cast with the abutments in place was used to fabricate the final fixed prosthesis
Other Applications: Fixed Prostheses
The prostheses were fabricated on the master working casts and then placed in the patient’s mouth to confirm fit, function and appearance.
Other Applications: Fixed Prostheses
Final fixed prosthesis in the maxilla
The result is a secure and natural looking dentition
Other Applications: Fixed Prostheses
Other Applications: Ectodermal Dysplasia
Other Applications: Ectodermal Dysplasia
Other Applications: Ectodermal Dysplasia
Other Applications: Ectodermal Dysplasia
Other Applications: Ectodermal Dysplasia
Other Applications: Ectodermal Dysplasia
Other Applications: Ectodermal Dysplasia
Other Applications: Ectodermal Dysplasia
Bar-clip type overdenture
Other Applications: Ectodermal Dysplasia
Other Applications: Ectodermal Dysplasia
Other Applications: Ectodermal Dysplasia
Conclusion You have now completed a review of the following
topics as stated at the beginning of the program:
Tooth loss and its consequences The evolution of today’s dental implant The importance of osseointegration and the factors that
influence it The steps involved in the dental implant process Some of the many applications of dental implant therapy
Questions regarding the course material can be directed to:Dr. Thomas D. Taylor at [email protected].
Thank you for completing the Dental Implant Course.
In order to receive credit for completing this course you must complete a 10 question, multiple choice test and receive a
passing score of 80% or higher. You will have an unlimited number of attempts to take the test.
Please copy and paste or click on the link below which will redirect you to the test. Please note that it may take up to
10 seconds for the test to begin.
https://cignaforhcp.cigna.com/app/provider/help/BUDCS0082a_web/player.html