Disclaimer This presentation is reprinted by Cigna with the permission of its author, Dr. Thomas Taylor. The health information in this presentation is

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


“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


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.



Physiological Consequences of tooth loss Changes in Intraoral Structure

Some remaining alveolar ridge Very little remaining alveolar ridge


Traditional Solutions for Tooth loss include: Fixed partial dentures Removable complete or partial dentures


Fixed partial dentures can lead toNegative effects on adjacent healthy teethRecurrent cariesPeriodontal disease


DENTURES


At best 17% as efficient as real teeth!At best 17% as efficient as real teeth!


Surgical Attempts to improve the denture bearing foundation have included:

VestibuloplastyVestibuloplasty OsteotomyOsteotomy ImplantologyImplantology


Soft tissue surgery- vestibuloplasty


Hard tissue surgery- osteotomy

1 month post surgery 6 months post surgery 1 year post surgery


Immediately after osteotomy One year after osteotomy


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


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)


ENDOSSEOUS IMPLANT “within the bone”

blade-shaped implants

Epithelial down growth over time with blade implants

Blade Implant


BLADE IMPLANT FAILURE

Alveolar bone

Scar tissue

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.


Posts remain above the gum tissue as anchors for a prosthesis

Metal framework lies on top of the mandible Subperiosteal

Implants


Subperiosteal Implant Failure

Down growth ofepithelium and exposure of the 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.


Radiographic and intraoral views of a transmandibular staple 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


Per Ingvar BrPer Ingvar Brånemark, MD, PhDånemark, MD, PhD

Professor of OrthopedicsProfessor of OrthopedicsUniversity of GothenburgUniversity of Gothenburg


Radiograph of one of the first human titanium implants placed in 1965

Titanium dental implant in the jaw of a dog


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


Titanium Highly corrosion resistant Lightweight metal Conducive to osseointegration



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


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.


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: Implant Supported Overdenture

O-Ring or Stud Retained OverdentureAnd

Bar-Clip Type Overdenture


Initial placement

After healing

Non-splinted implantswill support an overdenture


Removal of the healing caps reveals the implant bodies

Ball-shaped attachments (abutments)



Impressions are taken to properly fit the overdenture


Stud recipient sites


Other Applications: Fixed Denture


Abutment posts

Small spaces allow for cleaning the prosthesis and abutment posts

Hybrid design


Other Applications: Fixed Prostheses

Radiograph and intraoral images of a patient with a failing maxillary fixed restoration and removable partial denture.


Surgically placed implants in the maxilla and mandible


4 anterior and 4 posterior implants were placed in the maxilla

4 posterior implants were placed in the mandible


Impression copings were used to make the master impression A temporary bridge was also used during the healing process

Impression copings

Temporary bridge


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.


The master working cast with the abutments in place was used to fabricate the final fixed prosthesis


The prostheses were fabricated on the master working casts and then placed in the patient’s mouth to confirm fit, function and appearance.


Final fixed prosthesis in the maxilla

The result is a secure and natural looking dentition


Other Applications: Ectodermal Dysplasia








Bar-clip type overdenture




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

Documents

Disclaimer This presentation is reprinted by Cigna with the permission of its author, Dr. Thomas Taylor. The health information in this presentation is