Implants - definedSurgically inserted into boneUsed as anchors to support a prosthetic Replace missing teeth in partially and/or fully edentulous areasMay be single tooth or several teeth prostheticPotential for ultimate stability for prostheticRelies on integration with natural bone/tissues for retention and sustainabilityVideo

Implants Basic DiagramsProstheticsImplants

Implants Basic DiagramsRelies on integration with bone (new bone growth) for support.OsseointegrationThere must be a closed interface (implant to oral tissue) for success.

Types of Implants:Endosseous resides partially in boneSingle tooth replacement thru denture supportScrew-shapedMost common type

Types of Implants:

Types of Implants:Subperiosteal: rests on alveolar ridge, no bone invasionLess invasive, less stableSupports dentureTransosteal: placed through the mandible (only)Attachments reside above ridgeRarely used

Types of Implants:

Types of Implants:

Implant Materials:Titanium:Used as almost pure metalCorrosion resistantStrong & lightweightGreat biocompatibility

Implant Materials:Ceramics:Most biocompatible Formation of hydroxyapatite at surfacePotential for chemical bond between bone & implantCoated Metals:Combines strength of metal with good interface potential of ceramic

Implant Materials:Prosthetics & attachments:CrownsPFMs most commonCould be gold, ceramic, compositeAttached by screws or cementedDenturesTraditional materials - acrylicAttached by various fasteners: clips, balls, screws, etc.

Implant Materials:

Placement of Endosseous ImplantSoft tissue flap is laidPremeasured implant (body) placed into bone and covered entirely with soft tissueHealing: weeks - months

Placement of Endosseous ImplantThe soft tissue is removed, exposing the implant, and a healing cap is placedHealing: several weeks

Placement of Endosseous ImplantHealing cap is removed and an abutment is placedAbutment is prepared (post/cylinder added) & impressed for prostheticSent to lab for fabricationImplantAbutment

Placement of Endosseous ImplantCrown (or other prosthetic) is seated with cement or screw (or other fastener)

Procedure: Diagrams

Patient Selection:Highly motivated, healthy patientTime-consuming procedure (months of healing post-sx)No systemic diseases or conditions that impact healing & sustainability of implantSubstantial bone supportMust be able to practice good OH

Maintenance of Implants:Great OH by patient:Toothbrushes, floss, interdental aids, etc.Caution during prophylaxis:Scaling with conventional instruments may damage the titanium surfaceSonic instruments are contraindicated!Use a very mild abrasive with rubber-cup prophy

*Osseointegration = biologic bonding of tissue with implant epithelial tissue and bone*See text page 313 for subperiosteal diagramOther text for transosteal diagram *Combined:Metal implant coated with ceramic material like hydroxyapatite to increase potential for bond with bone*The body of the implant is placed (hole cut into bone to fit implant) no healing cap, no abutment/attachment piece soft tissue closed for healing time.*Diagram 1: implant placed - post-sx; left sub-epithelial for bone & tissues to heal Healing several weeks to months. Bone integration begins.Diagram 2: Implant surgically revealed a healing cap is placed to allow for healing of epithelium to implant and continued bone integration. Several weeks healing.Diagram 3: The abutment is screwed into the implant.Diagram 4: A cylinder is placed into the abutment to act as a post prepped for the prosthetic. Impressions are taken and the prosthetic is fabricated upon the cylinder by the lab. The crown is then seated via cementation or screw onto/into the abutment.*