Dr. Mohammed Rhael
Tikrit dentistry college
•The jaws may not “bite ”together properly, thus affecting the
function of mastication/chewing
•Pain na ot eud swaj/selcsum laicaf eht ni improper bite
•Difficulty with speech
•Aesthetically unpleasing yam selcsum laicaf eht sa‘ sag ’and
gaps in the teeth might appear unsightly
•Tilting : of neightbouring teeth
•Supra-eruption : of opposing teeth
•Food entrapment gnidael spag eht ni noitalumucca euqalp dna
dna yaced erom ot gum disease
•Last but not the least; your confidence gnitaeb a ekat thgim
ni egnahc eht fo esuacebecnaraeppa
Stages of bone healing after tooth extraction
Bleeding and clot formation
Granulation tissue formation ( within 2-3 days )
Fibrin clot organization ( first 4 weeks)
Woven ( immature ) bone formation (4-8)weeks
Lamellar (mature ) bone development ( 8-12 weeks )
Bone stabilization (12 -16 weeks )
Factors influencing edentulous bone loss
new studies show relation between depression and bone resorption.
The link may be in part due to the hormones that are released in those with depression, which can break down
Particularly in women, estrogen plays a large role in bone density .
When women begin menopause estrogen begins to drop ,
For good measure it is important to consume a calcium-rich diet and exercise in order to keep bones strong.
calcium is the key to healthy bones.
Adult over the age of 50 recommended daily intake of calcium is 1,2 milligrams .
salt, alcohol and caffeinated beverages can decrease bone density ,
A lack of physical activity decrease bone density .
When stress is added to bones it forces them to build new cells to make them stronger, thus building up
Methods for replacing missing teeth
Fixed bridge ImplantsRemovable denture
dental implant : A prosthetic device made of alloplastic materials implanted into the oral
tissues beneath the mucosa or within the bone to provide retention and support for
removable and fixed dental prosthesis .
•Dental implant surgery can offer a welcome alternative to dentures or bridgework
that doesn't fit well and can offer an option when a lack of natural teeth roots
don't allow building denture or bridgework tooth replacements.
Types of dental implants
Time dependent healing process , where by
clinically rigid fixation of alloplastic material
is achieved and maintained during functional
Osseointegration is also a measure of implant stability
two different stages: : primary and secondary
Primary stability of an implant mainly comes from mechanical engagement with compact bone
,Secondary stability on other hand, offer biological stability through bone regeneration and remodeling.
The former is a requirement for secondary stability
Measurment of oseointegration
invasive/destructive methods Following methods were included:
Removal torque analysis.
For more informations about measurement of oseointegration ,
please visit this web site :
Clinical Assessments for Osseointegration
Performing a clinical mobility test and finding that the implant is mobile is definite evidence that it is nonintegrated
Radiographs demonstrating a apparently direct contact between bone and implant have been cited as evidence of osseointegration
Radiolucent zones around the implant are a clear indication of its being anchored in fibrous tissue, Whereas the lack of such zones is
not evidence for osseointegration.
The use of a metal instrument to tap the implant and analyze the transmitted sound may, in theory, be used to indicate a proper
Clinical assessment of
patient need dental implant
TWO sTAGE IMPLANT PLACEMENT
Also known as the “submerged” or “delayed” approach
The implant was inserted in a first surgery and submerged for three to six months to permit osseointegration.
In a second surgical procedure, the implant was exposed, its cover screw removed, and the implant was then
fitted with an abutment and the prosthetic phase of treatment was completed.
The two-stage approach is sometimes uncomfortable for the patient but has a proven record of success over
It continues to be a valuable surgical option when primary stability cannot be achieved, or if extensive pre-
surgical or concurrent bone augmentation is required
A mucoperiosteal (full-thickness) flap is reflected up to or slightly beyond the level of the mucogingival junction,
exposing the alveolar ridge of the implant surgical sites.
The bone at the implant site(s) must be thoroughly debrided of all granulation tissue.
Once the flaps are reflected and the bone is prepared (i.e., all granulation tissue removed and knife-edge ridges
flattened), the implant osteotomy site can be prepared.
A series of drills are used to prepare the osteotomy site precisely and incrementally for an implant.
A surgical guide or stent is inserted, checked for proper positioning, and used throughout the procedure to
direct the proper implant placement.
0 Implant is inserted into the prepared osteotomy site with a handpiece or handheld driver
0 Tissue approximation to achieve primary flap closure without tension
Implant site preparation
ONE-STAGE IMPLANT PLACEMENT
When aesthetics are not of concern, the cover screw or healing cap of the dental implant may be left exposed
during healing process and osseointegration period .
though several prerequisites must guide proper patient selection for this approach:
•The patient must have bone quality (ideally type I or II) and quantity sufficient to ensure primary stabilization
(the initial engagement between the bone and implant), i.e., no GBR required.The ISQ system is essential to
confirm stability in this instance.
• An adequate circumferential zone of keratinized gingival tissue must be present.
•The abutment must precisely fit the implant.
•The abutment must be tightened to the proper torque value as dictated by the implant manufacturer.Torque
values are measured in N/cm and are different for each dental implant system. Using the proper torque value
is critical in order to prevent undue loosening.
• Abutment height must not compromise occlusion, and absolutely no contact or loading with the opposing
keys for successful preparation
Always begin with pilot drill
Don’t miss anatomy
Maintaine vitility of bone
Complications of dental implant
Poorly positioned implant
Damaged to mucosa and adjacent teeth
Damaged to bone (lateral perforation , alveolar or jaw
Perforation to maxillary sinus or nasal floor
Damage to nerve
Loose implant (poor primary stability)
Hemorrhage during surgery
Bleeding ( secondary )
Infection ( peri-implantitis )
Criteria for success
Implant not mobile when tested clinically
A radiograph does not show any evidence of periimplant radiolucency
Vertical bone loss is less than 0.2 mm annually after the first year of service of the implant
Absence of persistent singns and symptoms as pain , infection,paresthesia
Asuccessful rate of 85% at the end of a 5% years observation period and 80 % at the end of a 10
Causes of implant
Poor quality and quantity of bone and soft tissue
Patient medical condition
Unfavorable patient habits (bruxism , long term smoking ,poor oral hygiene,.)
Inadequate surgical analysis and technique
Inadequate surgical analysis and technique
Suboptimal implant desin and surface characteristics
Implant position or location
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