This document discusses the history of dental implants from ancient Egyptians using gold wires to stabilize teeth to modern developments like osseointegration and new implant materials and designs. It covers early uses of materials like gold, porcelain, and alloys as well as pioneers in the field like Branemark. The key development was Branemark's discovery of osseointegration in the 1960s which led to greater success and acceptance of dental implants. Modern implants are classified by material and design features to optimize stability and integration with bone. Patient evaluation and risk factors are also important considerations for dental implant treatment planning.

1. Marwan M. El Said
BDS. MSc.

2. History of dental implant
• 2500 B.C. the Egyptians used gold wire ligatures
to help stabilize damaged or loose teeth.
• The Mayans used the first known implants 400
years ago
• Maggiolo used gold implants in 1809
• Harris 1887 used porcelain implants
• Lambotte used gold, silver , brass, copper and
magnesium and identified corrosion of metal in
human tissue

4. • The first root form two pieces implants used
by Greenfield made from iridoplatinum .
• Strock introduced cobalt chromium
molybdenum alloy in 1938 with 15 years
fowlloup .
• Strock reported direct bone implant interface
in 1940 and called it bone fusing or ankylosis
• Branemark began his studies in 1952 on bone
marrow healing
• 1960s 10 years animal studies o dogs revealed
complete implant integration

5. • 1965 Branemark started human implant
clinical studies and the results were reported
in 1977
• In 1988 National institute of health recognized
dental implants and stressed the necessity for
advanced education

6. • The term osseointegration was first described
to be direct bone to implant interface on the
microscopic level
• Now osseointegration described to be direct
bone to implant interface on the microscopic
level and rigid fixation “ no movement when
applying force of 1 to 500 g”
• modern dental implants : An endosteal
alloplastic material surgically inserted into
residual bone ridge

7. Dental implant classification

8. According to material
• Pure titanium (cpTi grade 4)
• Titanium alloy (Ti 6 Al 4V)
• Ceramic
• Polymers

9. Pure titanium grade 4
 Grade is have the most oxygen content
(0.4%)
 Good Osseointegration
• Titanium oxide layer
 Low physical properties
• High corrosion, low strength ,difficult to
manipulate

10. Titanium alloy (Ti 6 Al 4V)
 Aluminum increases the strength and decrease
the weight of the alloy.
 Vanadium acts as beta-phase stabilizer and
increase the strength

11. Ceramic implants
• Advantages
Biocompatible made from Zirconia
More esthetic
All ceramic restorations and metal free dentistry
• Disadvantages
One pice implant only
No osseointegration
no alteration of the abutment portion
High cost

20. Polymer implants
• methyl methacrylate resin
• Not biocompatible but biologically tolerable
• inferior mechanical properties
• lack of adhesion to living tissues
• adverse immunologic reactions.

21. Implant design
• Macroscopic Features:
Body Design
Thread geometry
Platform
Crest module and abutment connection
Abutment
• Microscopic Features
implant materials
surface morphology
surface coatings

22. Macroscopic Features
• Body Design
subperiosteal frame-like
transmandibular implants
endosseous
• Bladelike
• Pins
• Root form implants
cylindrical
tapered screw shaped

23. subperiosteal frame

24. subperiosteal frame

25. subperiosteal frame

26. transmandibular implants

28. transmandibular implants

29. Endosseous implants
• Bladelike

30. pins

31. Cortically fixed @ once

35. Basal implants

38. Cylindrical implant

39. tapered screw shaped implant

40. tapered screw shaped implant

41. tapered screw shaped implant
Advantages of the tapered form implant :
allow for placement in narrow spaces
better stability for immediate placement
better distribution of compressive forces.

42. • Tapered screw implants can be :
Two piece implant
Single piece implant

43. Submerged
Non-submerged

44. Solid
Hollow
Vented

46. Thread geometry
• understanding of the forces an implant might
endure is essential to the concepts of implant
thread geometry
• three main types of load an implant may
endure at the interface between the implant
surface and bone.
• These three forces are compressive, tensile
and shear

47. Forces distribution
Tensile and
shear forces
Compressive
forces
unfavorable
favorable

48. • Thread pitch refers to the distance from the
center of the thread to the center of the next
thread .
• 𝒑𝒊𝒕𝒄𝒉 =
unit length
𝒏𝒖𝒎𝒃𝒆𝒓 𝒐𝒇 𝒕𝒉𝒓𝒆𝒂𝒅𝒔

49. • If implant length is the same, a smaller pitch
means there are a greater amount of threads

50. • Implants with more threads (i.e. smaller pitch)
were found to have a higher percentage of BIC
and increase resistance to vertical forces

51. • The lead is the distance from the center of the
thread to the center of the same thread after
one turn.

52. • this could be the distance the implant would
advance if it was advanced one turn

53. • implant could have a single ,double or triple
thread design in which two or three threads
run parallel to each other

54. • maintain a high level of resistance to vertical
forces and level of BIC at the same time as
allowing for increased speed of implant
insertion.

55. • Thread depth the distance from the tip of the
thread to the body of the implant

56. • A shallow thread will be easier to insert into
dense bone
• A deep thread will allow for much greater
primary stability specifically for situations such
as soft bone or immediate implant sites

57. • Thread width is the distance in the same axial
plane between the coronal most and the
apical most part, at the tip of a single thread.

58. • The face angle is the angle between the face
of a thread and a plane perpendicular to the
long axis of the implant.

59. • A small face angle will increase tensile and
compressive type forces,
• while increasing the face angle has been
shown to result in an increase of shearing
forces.

60. • Thread shape describes the geometry of the
implant thread
• five types of thread geometry V-shape,
square, buttress, reverse buttress and spiral

64. Implant platform

65. Implant platform

68. Implant platform switching

73. Implant abutment connection
• External hex
• Internal hex
• Mores taper

79. Abutments

84. Microscopic Features
• Implants can be
Smooth
Machined
 roughed
Coated

90. Patient evaluation and treatment
planning

91. Oral surgery
prosthodonticsperiodontics

92. Extra oral examination
• Facial symmetry
• Mid line
• Occlusal plane
• Smile line
• Any other facial features
• Palpation of facial muscles and TMJ
• Palpation of regional lymph nodes
• Palpation of the thyroid gland

93. Medical history
• Should be obtained for every implant
candidate
• It will set the tone fore the entire treatment
• Give the warm and caring impression
• The patient should understand medical history
value to appreciate your work

95. The disease control is
more important than
the disease itself. (Dios y cols; 2013)

96. contraindications to implant therapy
• Absolute contraindications: dental implants
cannot be considered
• Relative contraindications: dental implants
may be considered only after a specific
problem has been solved
• Local contraindications: dental implants may
be considered by taking extra precautions
regarding problems involving the mouth or
jaws

97. Absolute contraindications
• Major allergies
(Specifically to the anesthetic used during surgery or titanium )
• Risks:
 post-operative swelling
 Anaphylactic shock
 Death.
• Solutions:
 Finding an anesthetic tolerated by the patient.
 Finding an alternative to conventional dental implants.

98. Absolute contraindications
Young age
• Risks:
Not enough space to insert the implant in the alveolar
bone
Insufficient space for the artificial crown of the implant
Having to redo the procedure when growth is completed.
• Solutions:
Wait until the growth of the jaws is completed (at the age
of 17 or 18)
 Finding an alternative to conventional dental implants.

99. Absolute contraindications
• Patients requiring organ transplant
• Risks:
Post-operative infection due to long-term treatment
with anti-rejection drugs that suppress or slow down
the immune system
Osseointegration failure.
• Solutions:
Finding an alternative to conventional dental
implants.

100. Absolute contraindications
• Autoimmune diseases like AIDS
• Risks:
Osseointegration failure.
Post-operative infection.
• Solutions:
Finding an alternative to conventional dental
implants.

101. Absolute contraindications
• Cancer
• that is not in remission, treated with bisphosphonates
or required radiotherapy treatments in the jaw area
• Risks:
Osseointegration failure.
Post-operative infection.
Altered or slow healing.
• Solutions:
Cancer with radiation therapy: use strict asepsis during the
procedure, under general anesthesia, and work together
with the radiotherapy team.
Finding an alternative to conventional dental implants.

102. Absolute contraindications
• Cardiovascular disease
• recent myocardial infarction, valvular disease,
heart failure
• Risks:
Death
• Solutions:
Finding an alternative to conventional dental
implants.

103. Relative contraindications
• Smoking, drug addiction, and alcoholism
• Risks:
Post-operative infection;
Longer healing time;
Decrease in the effectiveness of the immune system
to fight gum and bone diseases
Osseointegration failure.
• Solutions:
Stopping smoking, drinking alcohol or consuming
drugs before the procedure, at least a week after and
ideally during the convalescence and even beyond

104. Relative contraindications
• Pregnancy
• Risks:
Parts of the procedure that can endanger the fetus
use of local or general anesthesia
 X-rays.
• Solutions:
Wait until after childbirth to perform implant surgery.

105. Relative contraindications
• Uncontrolled diabetes
• Risks:
 Post-operative infection;
 Onset of periodontal or dental disease;
 Longer healing time.
• Solutions:
 Managing diabetes;
 Use strict asepsis during surgery;
 Take antibiotics before the procedure to reduce the risk of infection.

106. Relative contraindications
• illness requiring anticoagulants
• Risks:
More abundant and uncontrollable bleeding (during
and after surgery).
• Solutions:
Consult the physician who prescribed blood thinners
to see if they can be stopped or changed before and
during surgery;
Take extra precautions during the procedure to
prevent bleeding.

107. Relative contraindications
• Autoimmune disease (e.g.: lupus, rheumatoid
arthritis, etc.)
• Risks:
Post-operative infection;
Longer healing time.
• Solutions:
Take antibiotics before the procedure to reduce
the risk of infection;
Use strict asepsis during surgery.

108. Relative contraindications
• Untreated psychiatric or psychological problems
• Risks:
Compromised security of the surgeon or the patient during
the procedure;
Patient dissatisfaction with the final result because of
unrealistic expectations.
• Solutions:
Evaluating the psychiatric or psychological problem to
determine if it can be controlled by medication (in
collaboration with the patient’s physician);
Finding an alternative to conventional dental implants.

109. Relative contraindications
• Osteoporosis and other bone diseases
• Risks:
Osseointegration failure.
Premature loss of the implant.
Fracture of the jaw.
• Solutions:
Finding an alternative to conventional dental
implants.

110. Relative contraindications
• Lack of motivation from the patient for the treatment
and postoperative follow-up
• Risks:
Osseointegration failure;
Post-operative infection;
Longer healing time.
• Solutions:
Making the patient aware of the rigorous discipline
required for a successful treatment;
Finding an alternative to conventional dental implants.

111. Local contraindications
 Insufficient alveolar bone density or volume
 gingival recession or other periodontal disease
 Bruxism
 clenching
 Unfavorable position of the lower alveolar nerve and
other anatomical structures of the mandible
 Unfavorable maxillary sinus anatomy
 Poor oral hygiene or tooth infection near the site of the
implant
 Lesions in the mouth (oral dermatosis)
 Malocclusion

112. Are orthodontic treatments a contraindication
to implants?

113. Laboratory investigations
• Complete blood count “CBC”
• Bleeding profile
Platelet count
Bleeding time
Partial thromboplastin time “PPT”
International normalized ratio “INR”
• Glycosylated hemoglobin “HbA1c”

114. Dental History
• Chief complaint
• Pain/emergency
• Past dental treatment
• Past dental experiences
• Previous dental prosthesis (How long?)

115. intraoral evaluation and treatment
planning
• Bone width
• Bone height
• Bone type
• Number of missing teeth
• Important anatomical structures
• Inter occlusal space
• Opposing arch
• Crown root ratio
• Soft tissue
• Prosthetic option
• Patient expectation
• Financial considerations

117. • What are the causes of increased failure
rates?
• Why is the patient seeking dental treatment?
• What are the patient priorities ?

118. Biological risk factors
Vs
Biomechanical risk factors

119. Implants success rate is about 97%
VS
implants are one of the treatment
modalities for replacement of missing
teeth