Introduction to Dental
Implant and Osseointegration
Hassanien A. Aljumaily
Oral & Maxillofacial Surgeon
The dental practitioner who starts dental
implant must know their scientific basis,
must receive proper training, and must
have clinical experience.
Missing teeth may result in a functional and
cosmetic deficit
Usually replaced with dentures or bridges
Dental implants offer an alternative
Implants are inserted into the jawbones and
used to support dental prostheses
A perimucosal device which is biocompatible
and biofunctional and is placed within the
bone associated with the oral cavity to provide
support for fixed or removable prosthetics.
A direct structural and functional connection
between ordered living bone and the surface
of a load carrying implant
P-I Branemark
A direct bone contact as observed histologically
may be indicative of the lack of a local or
systemic biological response to that surface. It is
therefore proposed that osseointegration is not
the result of an advantageous biological tissue
response but rather the lack of a negative tissue
response
the concept of osseointegration has been
defined at multiple levels such as clinically ,
anatomically , histologically, and ultrastructurally
"father of modern dental
implantology."
Discovery of Osseointegration
The concept of osseointegration, defined as a
direct contact of living bone with the surface
of an implant at the light microscopic level of
magnification, was an accidental discovery in
the early 1960’s by physician and Professor
Per-Ingvar Brånemark
In 1952 he was working on his thesis,
studying bone regeneration and microscopic
circulation of bone marrow healing in rabbits.
He developed a titanium chamber to study
wound healing. This device was implanted in
the bone of a rabbit. At the end of the study,
when he wanted to remove the chamber from
the bone, it could not be removed because the
bone had fused (osseointegrated) to the
titanium surface.
1952-1960 Vital microscopy
1960-1968 Repair and regeneration of bone
and marrow
1965 First jaw implant
1965- Clinical research
Subperiosteal Implants
In 1949 by Goldberg and Gershkoff. They are custom
made and are of 4 types:
Unilateral.
Interdental.
Total.
Circumferential.
Transosseous Implants
Introduced by Small 1968
This implant modality features a plate that is placed against the
exposed inferior border of the mandible, with extensions that
pass from this plate through the symphyseal area, out of the
crest of the ridge, and into the oral cavity to fixate the dental
prosthesis.
Endosseous Implants
Plate/Blade implants
Introduced by Linkow in 1966, they are supplied
in one-stage or two-stage varieties.
Their success rate was under 50% and they are
no longer used today.
Root form Implants
These implants are designed to resemble the shape of a
natural tooth root. They usually are circular in cross section.
Root forms can be threaded, smooth, stepped, parallel-sided
or tapered, with or without a coating, with or without grooves
or a vent, and can be joined to a wide variety of components
for retention of a prosthesis.
•One-stage (semi-submerged).
•Two-stage (submerged).
Region of Implant Minimum Integration
Placement Time
Anterior mandible 3 months
Posterior mandible 4 months
Anterior maxilla 6 months
Posterior maxilla 6 months
Into bone graft 6 to 9 months
Partially edentulous
Single tooth
Fully edentulous
There is one absolute contraindication
Unstable dental disease
Unstable systemic diseases
Structure Minimum Required Distance
Buccal 1 mm
Lingual plate 1 mm
Maxillary sinus 1 mm
Nasal cavity 1 mm
Incisive canal Avoid midline maxilla
Interimplant distance 3mm
Inferior alveolar canal 2 mm from superior aspect of bony canal
Mental nerve 5 mm from anterior of bony foramen
Adjacent natural tooth 1 mm
Inferior border 1 mm
BIOLOGICAL CONSIDERATION
FOR OSSEINTEGRATION
SOFT TISSUE -TO –IMPLANT INERFACE
BONE TO –IMPLANT- INTERFACE
Gingiva 0.69 mm
Epithelium 0.79 mm
Biologic width 1.86
mm
Connective tissue 1.07 mm
The emergence profile is the portion of the implant-
abutment-restoration complex that extends from
the bone crest to the free gingival margin. Generally
this area is made up of the abutment, though in
screw-retained restorations
Biomaterial
Design
Surgical procedure
Pure titanium
Micro-enhanced pure titanium
Plasma-sprayed titanium surfaces
Plasma-sprayed hydroxyapatite surface
roxolid
Screw-shaped
Cylinder-shaped
Tapered screw
Platform switching, platform shifting
Is whenever an abutment is used that is smaller
in diameter than the implant platform.
Can help prevent crestal bone loss which is
fundamental for the implant’s long-term
success and stability.
It can also increase the volume of soft tissue
around the implant platform, helping to improve
the esthetic end result
Implant length
Implant diameter
Internal or external
Implant reconstruction & esthetic
Two-stages
One-stage
Delayed loading:
1. A tow-stage surgical protocol
2. One-stage surgical protocol
Immediate loading:
1. Immediate occlusal loading (placed within 48
hours postsurgery)
2. Immediate non-occlusal Loading (in single-
tooth or short-span applications)
3. Early loading (prosthetic function within two
months)
Potential problems with tooth- and
Implant- supported fixed partial dentures
1. Breakdown of osseointegration.
2. Cement failure on natural abutments.
3. Screw or abutment loosening.
4. Failure of implant prosthetic component.
Advance Implant Surgical Aspect
Sinus lift
Distraction osteogenesis
Immediate dental implant
Nerve mobilization
Bone expantion
The ITI has formalized a system of classification for dental implant procedures to support
clinicians at every level of expertise and experienceThis is based on the debate and
findings of an ITI Consensus Conference attended by a multidisciplinary group of 28
clinicians that was held in Mallorca in March 2007. It provides guidelines to a broad
variety of implant situations for both restorative and surgical cases, which has 3 levels of
difficulty:
Straightforward ( S)
Advanced ( A)
Complex (C)
This system provides general and site-specific criteria of Surgical and Prosthetic degrees
of difficulty to define case types.
Surgery – Straightforward
S
Simple surgical intervention Surgery – Complex
No anatomical risk
No surgical risk
Low complications C
Sufficient bone quantity
Sufficient vertical/horizontal
dimensions Complicated surgical intervention
Anatomical risk
Surgery – Advanced High surgical demands
A Expected complications
Edentulous maxilla
Challenging surgical intervention
Bilateral sinus grafting
Anatomical risk
Vertical augmentation
Little surgical risk
Graft harvesting
Possible complications
Complex soft tissue grafting
Single tooth esthetic gap in maxilla
High esthetic demands
Osteotome sinus lift
Immediate implant placement/loading
Simultaneous membrane technique
1. the individual unattached implant is immobile
when tested clinically.
2. No evidence of perimplant radiolucency is
present, as assessed on an undistorted radiograph.
3. The mean vertical bone loss is less than 0.2 mm
annually after the first year of service.
4. No persistent pain, discomfort, or infection is
attributable to the implant.
5. The implant design dose not preclude placement
of a crown or prosthesis with an appearance that is
satisfactory to the patient and the dentist.
Dental Implant Treatment Planning
How many teeth are missing?
What is the degree of bone loss?
Are the remaining teeth in a good position
and do they have a long-term prognosis?
What does the patient expect for an end
result?
What treatment will result in the best
cosmetic outcome?
What is the patient's budget?
Overall...
What is the
most practical and
feasible implant
treatment that will
produce optimal
chewing function and
optimal cosmetic results
in a timely and
affordable manner?
Evaluation of esthetic
treatment outcome
Assessment criteria-PES. (Pink Esthetic
Score)
Assessment criteria-WES. (White Esthetic
Score)
THAN
K YOU Thank You!
