Dental Implants

TERMINOLOGY:-
IMPLANT:-Any object or material, such as an
alloplastic substance or other tissue, which
partially or completely inserted or grafted into
body for therapeutic, diagnostic, prosthetic or
experimental purposes.

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DENTAL IMPLANT:-A prosthetic device or
alloplastic material implanted into oral
tissues beneath the mucosal or periosteal
tissues, and on\or with in the bone to provide
retention and support for fixed or removal
prosthesis.

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 Classification
1) Implant design
2)Implant properties
3)Implant attachment mechanism
 Implant design
1)ENDOSTEAL IMPLANT:-

-A device placed into the alveolar and/or basal

bone of mandible or maxilla and transecting
only one cortical plate.

-Developed in 1967 by Linkow and Roberts

Eg: Blade implant , Ramus frame

implant
2) SUBPERIOSTEAL DENTAL IMPLANT:-
-A castom made metal frame is placed beneath
the periosteum overlying bony cortex

-It provide support for a dental prosthesis by

means of posts or other mechanisms
protruding through the mucosa.

-Developed by Dahl 1940

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3)TRANSOSTEAL IMPLANT:-
A dental implant that penetrates both
cortical plates and passes through the
full thickness of alveolar bone.

They are also called as staple bone

implant, mandibular staple implant,
trans mandibular implant

 Combines both subperiosteal and

endosteal components

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4) Epithelial implants

- Inserted into oral mucosa

- It is a very simple surgical technique
- Disadvantage is painful healing
 Implant properties
Classified according to
Composition
Physical eg : Elastic moduli, Tensile
strength ,Ductility
Mechanical
Biological
Attachment Mechanism
1)OSSEOINTEGRATION:-

The apparent direct attachment or

connection of osseous tissue to an inert
alloplastic material without intervening
connective tissue.
BIOLOGY OF OSSEOINTEGRATION

A, Threaded implant in contact with the tissue. Threaded

socket in bone provides immobilization immediately
1 = Contact between fixture and bone (immobilization);
2 = hematoma in closed cavity, bordered by fixture and
bone;
3= bone that was damaged by unavoidable thermal and
mechanical trauma;
4 = original undamaged bone;
5 = fixture.
B, During unloaded healing period, hematoma becomes transformed
into new bone through callus formation(6) . 7 - Damaged bone, which
also heals, undergoes revascularization, and de- and remineralization.

C, After healing period, vital bone tissue is in close contact with

fixture surface, without any other intermediate tissue. Border zone
bone (8) remodels in response to masticatory load applied.

D, In unsuccessful implants, nonmineralized connective tissue (9)

forms in border zone at implant.
 Mechanism of osseointegration

Phase Timing Specific occurrence

1. Inflammatory Day 1-10 Adsorption of plasma proteins
phase Platelet aggregation and activation
Clotting cascade activation
Cytokine release
Nonspecific cellular inflammatory
response
Specific cellular inflammatory
response
Macrophage mediated inflammation.
 Phase Timing Specific occurrence

2. Proliferative phase Day 3 - 42 Neovascularization

Differentiation, Proliferation
and activation of cells.
Production of immature
connective tissue matrix.
 Phase Timing Specific occurrence

3.Maturation After Remodeling of the immature bone matrix

phase day 28 with coupled resorption and deposition of
bone.
Bone remodeling in response to implant
loading
Physiological bone recession.
 2) Fibro-Osseousintegration

Fibrous integration of tissue, or

interposition of healthy dense collagenous
tissue between the implant and bone”.
Implant Components
1) Fixture
-It engages bone
-It has different surfaces :
threaded, grooved,
perforated, plasma
sprayed ,coated etc
2) Transmucosal abutment
-Connection between implant fixture and
prosthesis
- Connected to fixture by screw or cemented
- It engages an external or internal hexagon on
the fixture to serve as an antirotation device
3) Prosthesis

- Attaches to abutment by screws , cement or

precision attachment
 Success of dental
implants
Mobility of implant should be less than 1mm
No evidence of radioluscency
Bone loss less than 1/3rd of height of
implants
Absence of infection, damage to structures
or violation of body cavities.

Given by Schnitman & Schulman

 Implant materials

Chemical composition

Metals Ceramics Polymers

Biological compatibility

Bio tolerant Bio inert Bio active

Biotolerant – Material that is not necessarily rejected but are
surrounded by fibrous layer in the form of a capsule.

Bio inert – Material that allows close apposition of bone on

their surface, leading to contact osteogenesis.

Bioactive - Materials that allow formation of new bone onto

their surface, but ion exchange with host tissue leads to
formation of a chemical bond along the interface (bonding
 Biological Chemical composition
biocompatibility
Metals Ceramics Polymers

Biotolerant Gold Polyethylene

Cobalt-chromium Polyamide
alloys
Stainless steel Polymethylmethacrylate
Zirconium Polytetrafluoroethylene
Niobium Polyurethane
Tantalum

Bioinert Commercially pure Aluminum oxide

titanium
Titanium alloy (Ti- Zirconium oxide
6Al-4V)
Bioactive Hydroxyapatite
Tricalcium
phosphate
Calcium
pyrophosphate
Fluorapatite
Carbon:vitreous,
pyrolytic
 Metallic Implants
Undergo surface modification
Passivation
Anodization
Ion implantation
Surface Texturing
Passivation
- Enhancement of oxide layer to prevent
release of metallic oxide
- Performed by immersion in 40% nitric acid

Anodization
-Electric current is passed through the metal
Ion implantation
- Bombarding the surface of an implant with
high energy ions upto a depth of 0.1
micrometer
- Increase the corrosion resistance through the
formation of TiN surface layer

Surface texturing
-increases syrface area upto 6 times and
enhances osseointegration
- Done by several methods like plasma spraying
with titanium, acid etching , blasting with
aluminium oxide.
 1) Titanium and alloys
Gold standard of implant materials
Titanium has several favourable properties which
include a -low specific gravity
-high heat resistance
- high strength
-resistance to corrosion
Most commonly used titanium products are pure
Ti and titanium alloys
Several alloys of titanium are used in dentistry.
Of these alloys, Ti 6Al-4V is the most widely used
Titanium alloys have sufficient strength to
resist fracture under occlusal load and a low
modulus of elasticity for uniform stress
distribution across bone implant interface
 2) Cobalt Chromium Molybdenum Alloy

High modulus (stiffness) and Low ductility.

Outstanding resistance to corrosion

Excellent biocompatibility

Commonly used for fabrication of custom design (e.g. :

subperiosteal frames) by casting.
Composition:
63% cobalt 30% Chromium – for passivation
5 % Molybdenum – Strength
Traces of carbon , magnesium, and nickel

Precautions:
Proper fabrication techniques should be used
Poor ductility so bending can be avoided so cannot be used for
blade form implants.
 3) IRON - CHROMIUM - NICKEL BASED ALLOYS
Surface is passivated to increase biocorrosion resistance.

High strength and ductility.

Used in wrought and heat treated condition.

Composition (Surgical austentite steel)

18% chromium - for corrosion resistance.
8% nickel - to stabilize austentic structure.
0.5% carbon - as hardener.
Precautions

Contraindicated in patients sensitive to nickel.

Most susceptible to crevice and pitting corrosion, so care

to be taken to preserve passivated surface.

Has galvanic potential, so avoid contact with dissimilar

metal.
 4) Other Metals and Alloys
Gold, Platinum, Iridium and alloys of these metals are being
used.

Have low strength that limits the implant design.

High cost and High density.

Due to its nobility and availability gold is continued to be

used as surgical Implant materials.
 Ceramics and Ceramic coated implant
system
CERAMICS

These are non organic, non metallic, non polymeric

materials manufactured by compacting and sintering at
elevated temperatures.

These are bio compatible high strength insulators.Have low

ductility and inherent brittleness are their limitations.
Classified into :
Bio non-reactive - Oxides of Aluminum, Titanium,
Zirconium
Bio active -Ca3(PO4), Hydroxyapatite
ALUMINUM, TITANIUM, ZIRCONIUM OXIDES

Used for Endosteal root form, plate
form implants


Have clear white cream or light grey
color so used for anterior root form


Minimal biodegradation

High modulus of elasticity THE TÜBINGEN IMPLANT OF ALUMINUM OXIDE HAS
SPECIFIC MICRO-IRREGULARITIES ON THE SURFACE,

Low fracture resistance CLAIMED TO ALLOW BONE INGROWTH.


Exhibit direct interface with bone
DISADVANTAGES

Exposure to steam sterilization results in measurable decrease in

strength of some ceramics. So dry heat sterilization is
recommended.

Scratches or notches may induce fracture initiating sites.

Although initial testing showed adequate mechanical strengths,

long term clinical results clearly demonstrate a functional design
and material related limitations.
BIOACTIVE AND BIODEGRADABLE CERAMICS
Calcium Phosphate Ceramics

The compositions was relatively similar to bone Ca 5(PO4)3OH

Color similar to bone.

Shows good bonding with bone so it can be used when

structural support is required under high magnitude loading.
Mixtures with collagen, active organic compounds as bone
morphogenetic proteins and with drugs have increased the
range of its applications.

It is used as a coating over the metallic implants.

Modulus of elasticity is very near to bone.

DISADVANTAGES

Low mechanical tensile and shear strengths under fatigue

loading.

Low attachment strength on some substrates.

Variable solubility depending on the product and their clinical

applications.
Hydroxyapatite is non porous with angular or spherical shape
particles
Their compressive strength is 500 Mpa and tensile strength is
50-70 Mpa.
PROPERTIES OF BIOACTIVE CERAMICS

Dense polycrystalline ceramics with small crystallites have

higher mechanical strength.

These ceramics are widely used as coatings on metallic

implant substrates.
Calcium phosphate ceramics have become a routine use by
plasma spray technique.

This technique increases the surface area which in turn

 TISSUE RESPONSE

The Ceramic implant surface responds to the local pH changes

by releasing Na, Ca, P and Si ions in exchange for H2 ions.

Si reacts with O2 to form Silica gel. As the concentration of

phosphorus and calcium increases at the surface they combine
to form calcium phosphate rich layer and the collagen fibers
become incorporated into it.
This way the functional integration with bone occurs
with the help of natural bone cementing substance
so the bond formed is strong.
POLYMERS AND COMPOSITES
These can be designed to match tissue properties and can be
fabricated at relatively low cost.

These include
polytetraflouroethylene (PTFE),
polyethyleneterephthalate (PET),
polymethylmethacrylate (PMMA),
polypropylene (PP),
 polysulfone (PSF),
silicon rubber (SR)
PROPERTIES

Polymers have low strengths and low elastic moduli and

higher elongation to fracture compared with other class of
biomaterials.

Relatively resistant to biodegradation compared to bone.

Most uses have been for internal force distribution
connectors intended to better simulate biomechanical
conditions for normal tooth functions.

Some are porous where as others are constituted as solid

structural forms.
DISADVANTAGES

Sensitive to sterilization and handling techniques.

Display Electrostatic surface properties.

Tend to gather dust or other particulate if exposed to semi

clean oral environments.

Cleaning the contaminated porous polymers is not possible

without a laboratory environment.

So the talc on the gloves or contact with towel or gauze

pad or any such contamination must be avoided.
 Other Implant Materials
CARBON AND CARBON SILICON COMPOUNDS

Extensive applications for cardiovascular devices.

Excellent Biocompatibility profiles and Moduli of

elasticity close to that of bone.
ADVANTAGES
Tissue attachment.

Thermal and electrical insulation.

Color control.

Provides opportunities for attachment of active

biomolecules.
LIMITATIONS

Poor Mechanical strength.

Time dependent changes in the physical characteristics.

Biodegradation could adversely affect Stability.

Minimal resistance to scratching or scraping.