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TRANSCRIPT
Introduction to
Dental Implant
A dental implant is a small, sturdy, titanium post that acts as the root structure would for a natural tooth
What is Dental Implant ?
History and Present Status of Implant
Dentistry
16 thDark stone ( Egyptian-South American)
17 thCarved ivory teeth
Ancient Implants
1809Gold implant e.20th Lead, iridium, tantalum, stainless
steel, and cobalt alloy 1913hollow basket iridium + gold wires
(Greenfield)
Early Implants
1937Adams’s submergible threaded cylindrical implant with round bottom
1938Strock’s (long term) threaded vitallium implant
(cobalt+chrome+molybdenum)
The modern implants appear to be variants or composites of some of the designs of early implants
Early Implants
1952Swedish surgeon,
Professor Per- Ingvar Branemark, coined the term
“osseointegration”- pure titanium comes into direct contact with the living bone tissue,
Modern Implants
1965 Dr. Brånemark placed his first titanium dental implant into a human
volunteer, a Swede named Gosta Larsson. He received implant at the age of 34, died at the age of 75, having used his implants for over 40 years
1981 Nobelpharma AB founded in to focus on dental implantology.(later to
be renamed Nobel Biocare)
Modern Implants
Other Different Types of Dental Implants
1967Linkow blade implant-in narrow ridge
1970Roberts and Roberts – Ramus titanium blade implant
Blade Implants
1943 Dahl of Sweden placed with 4 projecting post
Placing implants on and around bone rather than in it
CT-generated CAD-CAM model
Subperiosteal Implants
1975Small introduced transosteal mandibular staple bone plate
Limited to mandible only
Transosteal Implants
Component and Coposition of Dental
Implant
Component
Composition Titanium
implant: Titanium alloy
(Ti-6Al-4V)
Lightweight Biocompatible corrosion resistant
strong & low-
priced
Zirconium implant : Zirconium oxide (ZrO2)
High resistance to fracture and heat
Metal-free: white color of Zirconium substitutes the metallic appearance of Titanium
Indication and
Contraindication
What are the Alternative Solutions
Partial and Full Dentures
Crowns
Bridges
Inability to wear a removable partial or complete denture.
Need for long span fixed partial denture with questionable prognosis.
Unfavourable number and location of potential natural tooth abutments
Single tooth loss that would necessitate preparation of minimally restored teeth for fixed prosthesis
Indication
Medical: Terminal illness. Pregnancy. Uncontrolled metabolic disease Inability to restore with a prosthesis. Immune diseases Radiotherapy of head. Acute illness Bleeding or clotting disorder Osteoporosis with medication on Forxamex ( Bisphosphonate ) (?
)Dental: Anatomy- nerves too close,sinus, or insufficient bone quantity Local pathology- cyst, root stumps, gum problems Bad oral hygieneGeneral : Financial difficulty No Moivation or non cooperative History of immune deficiency Bleeding or clotting disorder
Contraindication
Update: OsteoporosisLisa L. Willett, MDFebruary 9, 2010
General Medicine Noon Conference
Today’s speaker has no conflict of interest to disclose. The University of Alabama School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
UAB School of Medicine designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit (s) Physicians should only claim credit commensurate with the extent of their participation in the activity.
Osteoporosis “Porous Bones”
Diminished bone mineral density◦ 2.5 SD below mean for normal
Disrupted bone microarchitecture Decrease in bone strength Increase in fracture risk 8 million women, 2 million men in US
American Association of Oral and Maxillofacial Surgeons Position Paper on Bisphosphonate-Related Osteonecrosis of
the Jaws 2009 Update
Journal of Oral and Maxillofacial Surgery May 2009;67(5):2-12
Bisphosphonate-Related Osteonecrosis of the Jaws
Definition: BRONJ
Current or previous bisphosphonate Rx
Exposed bone in maxillofacial region, 8 wks
No history of radiation therapy to the jaws
Oral bisphosphonates for osteoporosis and BRONJ
Case reports > 3 years treatment But much less than with IV monthly
bisphosphonates in cancer patients ◦ 0.06% Kaiser-Permanente (PROBE, n=13,000)◦ 0.01 – 0.04% Australian surveillance◦ 0.004 German Central Registry
Risk Factors for BRONJ Drug related: IV route, cancer doses Duration: > 3 years for oral treatment Local risk factors
◦ Dentoalveolar surgery - ↑ risk 7-fold extractions, implants, periodontal surgery
◦ Concomitant oral disease
Cancer + iv + dental procedure = 5 - 21-fold increased risk compared to cancer + iv without dental procedure
Prevention of Osteoporosis Adequate calcium 1,200 mg daily Adequate Vitamin D 400-1,000 IU daily Exercise Minimize risk factors
Risk Factors Tobacco Excessive alcohol Medications – steroids, dilantin Hyperthyroidism Hyperparathyroidism Low body weight Family history
Different Types of Implants
About 200 implant manufacturing companies in the world
800,000 dental implants were placed in the United States last year.
Anatomic Zicornium Dental Implant
Impalnt Made in China
Medical grade titanium Safe and durable Non-toxic side effects Corrosion-resistant Light weight
Nobel biocare31%
Straumann19%Biomet/3i
11%
Zimmer9%
Dentsply6%
Others24%
Market Shares of Major Implant Company
2009
Geographic Analysis
Europe42%
North Americas31%
APAC19%
RoW8%
Geography wise Market Share of Dental Implants Market
2009
Advantage and
Disadvantage
Preserve tooth structure. Preserve bone from resoption. Psychological improve quality of patient’
life. Hygienic. Function.
Advantage
To replace one or more teeth To provide support for a partial denture To increase the support and stability of full
upper or lower denture To enhance chewing comfort To increase confidence while smiling, talking
and eating To improve your overall psychological health To improve esthetic appearance and
regain over all confidence
Can be a costly alternative for replacing a single tooth
The length of time required from initial dental implant placement to implant restoration
Invasive surgical procedure
Disadvantage
Procedures
First Surgical Phase (Implant Placement)Under Local anesthetic the dentist places dental implants into the jaw bone with a very precise surgical procedure. The implant remains covered by gum tissue while fusing to the jaw bone.
Second Surgical Phase (Implant Uncovery)After approximately six months of healing. Under local anesthetic, the implant root is exposed and a healing post is placed over top of it so that the gum tissue heals around the post.
Prosthetic Phase (Teeth)Once the gums have healed, an implant crown is fabricated and screwed down to the implant.
Procedure
Clinical procedure: Surgical either one stage or two stage
(healing period in between). Prosthetic
Healing period: Implant placed in less dense bone required
more time for healing Mandible 3-4 months Maxilla 6 months Bone graft 6-9 months
http://www.youtube.com/watch?v=ZLms9455d_I&feature=related
http://www.youtube.com/watch?v=BRv6kxuD1ts&feature=related
http://www.youtube.com/watch?v=mmaXcThuou4&feature=related
Post-Operative Instruction
Diet FLUID INTAKE IS VERY IMPORTANT.
Bleeding Expect minor bleeding or OOZING from the operative
site. This bleeding may continue throughout the first day
Pain
Swelling Swelling usually develops during the first 12-24 hours
following surgery, often peaking on the 3rd post-operative day
Try to avoid smoking completely, as it tends to slow the healing process and may also contribute to infection & prolonged discomfor
Maintenance After Restoration
Maintenance◦Primary goal is to protect and maintain “tissue-integration”;
good oral hygiene is a key element!
Implant Guidelines
Water : 4 or 6 month recall Water : waterpik ( two times a day ) Water : gargle with drinkiing water
Water! Water! Water !
Waterpik
Fixed Hybrid Prosthesis
- Hygiene care with a proxy brush
Case Presentation
Single ImplantCase 1
Case 2
Case 3
Multiple ImplantsCase 1
Case 2
Case 3
Case 4
Single Arch Case 1
Full MouthRehabilitationCase 1
Case 2
Implant OverdentureCase 1
Case 2
Implant in Cancer PatientCase 1
Case 2