Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

recent advances in implant dentistry

brief review of recent advances in implant dentistry

  • Login to see the comments

recent advances in implant dentistry

  1. 1. Recent advances in Implantology Presented by Pallavi Chavan
  2. 2. Introduction ◉The science of implantology is highly dynamic. Ever since its introduction into the field of dentistry by Dr. Branemark, it has undergone numerous modifications and improvements. ◉With each improvement and advancement made, implantology has proved to be a boon in disguise to the society
  3. 3. Contents ◉Advances in Diagnostic imaging ◉Recent advances in Implant design ◉Advances in Implant materials ◉Advances in commercially available implant systems ◉Software simplifying treatment planning ◉Recent advances in Implant Abutments ◉Implant -Abutment connection ◉New concepts in Implant rehabilitation ◉Conclusion ◉References
  4. 4. Advances in Diagnostic Imaging
  5. 5. Imaging Phase 1: Pre- prosthetic implant imaging Phase 2: Surgical and interventional implant imaging Phase 3: Post- prosthetic implant imaging Determines the • Quantity, quality, and angulation of bone; •Relationship of critical structures to prospective implant sites • The presence or absence of disease at the proposed surgical sites. Evaluates the surgical sites during and immediately after surgery Evaluates the long-term change • Crestal bone levels around each implant • Changes in mineralization or bone volume.
  6. 6. ZONOGRAPHY ◉A modification of the panoramic x-ray machine for making cross sectional images of the jaws. ◉The tomographic layer is approximately 5mm. ◉For appreciation of spatial relationship between the critical structures and the implant site. Limitations: •Tomographic layers relatively thick . •Adjacent structures blurring and superimposition. •Not useful for determining the differences in bone density or for identifying disease at implant site.
  7. 7. Tomography ◉Tomography is the generic name formed by the greek words ‘tomo’(slice) and ‘graphy’(picture). ◉Enables visualization of a section of patient’s anatomy by blurring other regions above and below the site of interest. ◉For dental implant patients, high quality complex motion tomography is required.
  8. 8. Computed tomography (CT) ✘CT was invented by Sir Godfrey Hounsfield and was introduced in 1972. ✘Computed tomography (CT) is a digital and mathematical imaging technique that creates tomographic sections and allows soft tissues and hard tissues to be visualized simultaneously ✘Ideally, tomographic sections spaced 1 to 2 mm enable evaluation of implant site and 3D appearance of alveolus ✘With latest CT scanners, images with sectional thickness of 0.25 mm can be obtained
  9. 9. The advantages of CT based systems are ◉Uniform magnification ◉High contrast image with well-defined image layer, free of blurring ◉Easier identification of bone grafts or hydroxyappatite materials used to augment maxillary bone in sinus region ◉Multiplanar views ◉Three-dimensional reconstruction ◉Simultaneous study of multiple implant sites ◉Availability of soft tissue for image analysis
  10. 10. Disadvantages ◉Limited availability of reconstructive software ◉Higher dose of radiation ◉Lack of understanding of dentists ◉Lack of usefulness for implant interface follow-up because of metallic streak artifacts ◉Expense
  11. 11. Recent advances in Computed Tomography(CT) Tuned Aperture CT (TACT) ◉Tuned aperture computed tomography (TACT) by Webber is a relatively simple, faster method for reconstructing tomographic images ◉It is based on the concept of tomo-synthesis and optical-aperture theory ◉TACT uses 2-D periapical radiographs acquired from different projection angles as base images and permits retrospective generation of longitudinal tomographic slices (TACT-S) lining up in the Z axis of the area of interest
  12. 12. ◉ The overall radiation dose of TACT is not greater than 1 to 2 times that of a conventional periapical X-ray film. ◉The resolution is stated to be similar with 2-D radiographs. ◉ Artefacts associated with CT, such as starburst patterns seen with metallic restorations, do not exist with TACT.
  13. 13. The big concept! Cone Bean Computed Tomography
  14. 14. Cone Beam Computed Tomography Fan beam Cone beam
  15. 15. ◉Software programs incorporating sophisticated algorithms including back-filtered projection are applied to these image data to generate a 3D volumetric data set, which can be used to provide primary reconstruction images in 3 orthogonal planes (axial, sagittal and coronal). ◉CBCT is devoted to maxillofacial area to scan and visualize jaw bone lesions especially cancellous bone ◉It gives all the information of a CT but, at 1/8th the radiation dose and at a lower cost
  16. 16. ◉CBCT is categorized into large, medium, and limited volume units based on the size of their field of view (FOV) Large (FOV) • 15-23 cm • Maxillofacial trauma • Orthodontic use • TMJ diseases Medium FOV • 10-15 cm • Mandibulo- maxillary imaging • Pre-implant planning • Pathology Small FOV • < 10 cm • Endodontic applications
  17. 17. Advantages of CBCT ◉X-ray beam limitation ◉Image accuracy ◉Rapid scan time: 10–70 seconds ◉Software can be made available to the user ◉Dose reduction :Effective dose is 98% smaller than conventional CT ◉Reduced image artifact
  18. 18. Interactive computed tomography(ICT) •This technique enables transfer of the imaging study to the clinician as a computer file…. •The clinician’s computer becomes a diagnostic radiologic workstation with tools •An important feature of ICT is that the clinician and radiologist can perform “electronic surgery” (ES)
  19. 19. • With an appropriately designed diagnostic template, ES can be performed to develop the patient’s treatment plan electronically in 3 dimensions. •Transfer of the plan to the patient at the time of surgery can be accomplished by production of the computer generated, three-dimensional stereotactic surgical templates
  20. 20. Recent advances in Computed Tomography(CT) Microtomograph: Modification of CT, it is specially useful in acquiring serial sections of bone implant interface. Multi slice helical CT: The helical CT scan takes continuous pictures of the body in a rapid spiral motion, so that there are no gaps in the pictures collected.
  21. 21. Recent Advances in Implant Design
  22. 22. Mini implants ◉Mini dental implants (MDIs) are small diameter dental implants. ◉Are sometimes referred to as SDIs (small diameter implants), as well as NDIs (narrow body implants). ◉Diameter: 1.8mm to 2.9mm (less than 3mm) ◉Various lengths: 10, 13, 15 & 18 mm’s
  23. 23. ◉The MDI are available with either an O-ball head for use with removable or fixed dentures, or a square head for fixed prostheses or retrofitting a poorly adapted partial denture ◉The body connects the tip with the prosthetic head and can be a parallel sided cylinder or a progressively tapered cone ◉A small pilot bit is used to create the opening for the implant to be threaded into the bone. ◉The definitive implant supported crowns are usually delivered within 2 weeks of surgery
  24. 24. Advantages ◉Immediate loading, ◉Can be inserted in minimal tissues without relying on grafting techniques ◉Minimally invasive procedure ◉One-stage denture stabilization ◉Does not require osteotomy ◉Cost-effective ◉Can be placed with a simple technique in patients with ridge too narrow for conventional implants ◉.
  25. 25. Narrow-diameter implants: Are they a predictable treatment option? A literature review José-Luis Sierra-Sánchez Med Oral Patol Oral Cir Bucal. 2014 Jan 1;19 (1):e74-81. ◉The review included ◉Four randomized clinical trials ◉Ten prospective studies ◉Seven retrospective studies ◉The follow-up periods -12 months to 12 years. ◉Total of 1607 patients ◉The patient age - 13 to 87 years ◉2980 implants
  26. 26. ◉The recorded implant survival rates were above 90% in all the studies. Six studies published a survival rate of 100% at the end of the follow-up period ◉The lowest survival rate (90.9%) corresponded to the study published by Barter et al. ◉58 failures (implant loss) were recorded out of a total of 2980 implants ◉A larger number of failures were recorded with implants measuring ≤ 13 mm in length ◉Nineteen studies measured changes in peri-implant bone height after implant loading :0.065 mm the first year to 1.74 mm after a follow-up period of 10 years
  27. 27. ◉Araujo published a retrospective study on 3.3 mm implants placed in posterior areas and rehabilitated following an immediate loading protocol. Implant survival rate was 95.5% after 9 years of follow-up. ◉That same year, Degidi et al. published a study comparing delayed and immediate loading in narrow-diameter implants placed in both anterior and posterior zones. Survival rate was 99.4% after a mean follow-up of 20 months.
  28. 28. TRANSITIONAL IMPLANTS ◉Diameter ranges -1.8 to 2.8 mm ◉Length -7mm to 14mm. ◉Fabricated with pure titanium in a single body with treated surface. ◉Primary function is to absorb masticatory stress during healing phase ◉They should be placed at least 1.5 mm from adjacent teeth and the distance between any transitional implant and a definitive implant must be at least 1.5-2 mm
  29. 29. ◉The abutment head generally has a 5 degree taper, which makes it optimal for retention of cement retained prostheses. ◉Only one drill, a 1.5 mm or 2 mm twist drill is required for placement of the implants. Advantages : Provisionalisation of fully and partially edentulous jaws Undisturbed healing of bone grafts Effective way to generate aesthetic transitional appliances Allows evaluation of phonetics and function. Cost effective.
  30. 30. One – Piece Implants ◉The implant is machined from a piece of titanium that incorporates both the implant body and an integral fixed abutment in a single component. ◉3 diameters -3.5, 4.3, and 5 mm ◉ 4 lengths -10, 13, 15 and 16 mm
  31. 31. Clinical and radiographic evaluation of one-piece implants used for immediate function Jack a. Hahn, journal of oral implantology vol. 33(3)2007 ◉The aim of the present research was to evaluate the radiographic outcome of a 1-piece implant when used for immediate function in an ordinary patient pool ◉Forty-seven NobelDirect and NobelPerfect 1-piece implants (Nobel Biocare, Go¨teborg, Sweden) were placed in maxillae and mandibles.
  32. 32. ◉In this study 1 of the 47 implants had to be removed, resulting in a cumulative implant survival rate of 97.9% throughout the follow-up period ◉The mean marginal bone level relative to the reference point after 1 year of loading (0.78 - 1.60 mm), as well as after 2 and 3 years of loading, was located above the first implant thread ◉In this study, a bone level 2 mm apical to the reference point after 1 year of loading was observed at 2 implants (6%).
  33. 33. ◉The 1-piece implant design enables undisturbed healing of the peri-implant soft tissue and avoids disruption of the soft tissue seal when placing the definitive prosthetic restoration. ◉Annibali, et al reported a series of patients treated consecutively for first molar replacement according to : ◉ Immediate = group 1, ◉ Early = group 2 ◉ Late = Group 3 The implant survival rate: 91.7% for early implants 95.0% for immediate post-extraction implants 100% for implants placed in healed sites.
  34. 34. Short Dental Implants ◉A dental implant with length of 7 mm or less. (Friberg et al. 2000) ◉Any implant under 10 mm in length referred to as a ‘‘short’’ implant (Griffin TJ, Cheung WS. 2004) ◉A device with an intra-bony length of 8 mm or less. (Renouard and Nisand 2006) Indication : Atropic Jaw Proximity to vital structure Single crowns Overdentures
  35. 35. Advantages: 1. Bone grafting for height often unnecessary 2. Less money, pain, and time prior to restoration of the implant. 3. Simplified bone surgery. 4. Implant insertion easier.
  36. 36. ◉Goodacre, et al in 2003 reviewed , 2,754 implants - <10 mm 3,015 implants - >10 mm in length. ◉The failure rate of implants 10 mm or less was 10%, compared to a 3% failure rate of implants longer than 10 mm. ◉Ivanoff, et al in 1999 found an 8-mm-long, 5-mm-diameter implant failed 25% of the time in the maxilla and 33% of the time in the mandible. On the other hand, the 10-mm and 12- mm implants that were 5 mm in diameter reported no mandibular failure and a 10% failure in the maxilla. Misch CE Short Dental Implants: A Literature Review and Rationale for Use Dent Today. 2005 Aug;24(8):64-6, 68
  37. 37. ◉On the other hand, a retrospective report by Misch, et al was compiled from 2 private offices using a square thread implant body design (BioHorizons) rather than a v-shaped thread as primarily reported in the previous literature. ◉During a 3-year period, 126 patients received implants less than 10 mm long ◉Of the 437 implants there were 3 implant failures in the posterior mandible and 1 failure in the posterior maxilla (99% survival) ◉All these failures were implants 9 mm long and 4 mm in diameter.
  38. 38. Advances in Implant materials
  39. 39. ◉Previously implants had macro-irregularities like macroscopic threads, fenestrations, pores, grooves, steps, threads, or other surface irregularities that were visible. ◉However, difficulty in achieving initial stability, post implantation relative motion, adverse interfacial bone remodelling all lead to search for improvement of the surface quality of a titanium dental implant
  40. 40. BLASTING ◉Blasting -aluminium oxide, titanium oxide and calcium phosphate with particle size ranging from small, medium to large (150- 350 µm) ◉Blasting a smooth Ti surface with Al2 O3 particles of 25 µm, 75 µm, or 250 µm produces surfaces with roughness values of 1.16 to 1.20, 1.43, and 1.94 to 2.20, respectively. ◉A series of investigations have demonstrated a firmer bone fixation of the implant with an average surface roughness (sa) of 1- 1.5µm than those of smoother implants with an average surface roughness of 0.6µm
  41. 41. Blasting and Acid Etching ◉Acid etching can be done by using an HCL/ H2 SO4 mixture or by pickling in 2% HF/10%HNO3 . These processes leave pits and craters. ◉Alumina or TiO2 for blasting the surface: ◉Small - 25μm ◉large grit -0.25-0.5mm ◉medium grit - 250-500μm ◉Sand blasted and acid etched surfaces have a hydrophobic surface.
  42. 42. ◉The etching leads to the formation of Titanium hydrides and the replacement of hydride by oxygen results in the slow transformation of the implant surface, resulting in nanometre sized particles of titanium on the surface, which helps in protein adhesion on implant surface ◉Dual acid etching with HCl and H2SO4 heated above 100ᴼC has produced surface topography able to attach to fibrin scaffold and promote adhesion of osteogenic cells. ◉Sand blasting and etching can increase the rate and amount of the bone formation
  43. 43. Flouride Surface Treatments ◉This treatment enhances osseointegration and osteoblastic differentitation with increased expression of Cbfa1, osterix and bone sialoprotein ◉Fluoridated rough implants also withstood greater push-out forces and showed a significantly higher removal torque than control implants ◉However, detrimental effect of F on the corrosion resistance of titanium and titanium alloys has been extensively reported
  44. 44. Anodized Surface Implants ◉Anodized surface implants are implants which are placed as anodes in galvanic cells, with phosphoric acid as the electrolyte and current is passed through them – also c/a “Tiunite surface” ◉The surface oxides grow from the native state of 5nm to approximately 10,000nm ◉The sa of TiUnite is reported to be 1.1µm and its sdr 37% ◉Anodic oxidation results in the growth of a native titanium oxide layer and a porous topography, with the bone formation occurring directly on the moderately rough oxidized surface
  45. 45. Clinical and Radiographic Evaluation of Brånemark Implants with an Anodized Surface following Seven-to-Eight Years of Functional Loading David Gelb , Bradley McaAllister et al Int J Dent. 2013; 2013: 583567 ◉The aim of this study was to evaluate the clinical and radiographic long-term outcomes of dental implants with an anodized TiUnite surface, placed in routine clinical practice. 38 single prosthesis 22 FPDs 80 implants in maxilla 27 in mandible Mean marginal bone level change- 1.49 ± 1.03 mm 90.7% of cases- no visible plaque 9.3% -visible plaque No prosthetic complication
  46. 46. ◉Calandriello evaluated immediately placed anodized implants in 33 patients and found a mean marginal bone loss of 1.17 mm after 5 years ◉Friberg and Jemt compared 280 TiUnite implants to 110 machined implants in 111 patients and found marginal bone loss after 5 years to be 0.75 and 0.6 mm, respectively, with no significant difference between the two types of implants.
  47. 47. Laser etching and Micro Arc Oxidation ◉After the implants are ultrasonically cleaned, they are laser etched by using an Nd:YAG laser at a power of 50kw, frequency of 7.5khz and 16.4A current. ◉They are then processed in an electrolyte solution with 3.5% glyceroposphate disodium salt pentahydrate and 1.2% calcium acetate monohydrate by microarc oxidation (voltage 350v, frequency 800hz) for 15 seconds ◉Microarc oxidation produces a titania film with a porous structure and micropores of 1-5µm ◉The mechanism of osseointegration of the oxidized implants has been shown to be mechanical interlocking and biochemical bonding
  48. 48. Surface coating :Ti Plasma Spray ◉Porous / rough Ti surface have been fabricated by plasma spraying a Ti powder form of molten droplets at high temperature at temperature in order of 15000C, at 600m/s ◉ The Ti plasma spray after solidification often provides 0.04 – 0.05 mm thickness. ◉Ti A spray has been reported to increase the surface area of bone to implant interface (as much as 600%) and stimulate adhesion osteogenesis
  49. 49. ◉Advantages: Enhance attachment by increasing ionic interactions Increased load bearing capability by 25%-30% Increased tensile strength through ingrowth of bony tissues into 3D feature ◉Disadvantages  Cracking and scaling of coating because of stresses produced by elevated temprature processing Risk of accumulation of abraded material in the interface zone during implantation of TPS
  50. 50. Hydroxyapatite coatings ◉Hydroxyapatite [Ca10(PO4)6OH]2 coating was brought to the dental profession by DeGroot ◉HA forms a strong chemical bond with bone due to the presence of free calcium and phosphate compounds at the implant surface ◉The HA coating consists of amorphous and crystalline forms with a large density of cracks. ◉The top 1-2 µm of the HA layer being amorphous, while the rest of the crystalline layer is hexagonally packed
  51. 51. ◉Indicated: Fresh extraction sites. Newly grafted sites. Advantages : 1. Protection of surrounding bone against metal ion release from the substrate. 2. Reported chemical bonding between HA and living bone-intimate contact-biointegration 3. Partial dissolution of HA makes surrounding fluid rich in calcium and phosphate ions which trigger cellular differentiation and bone formation
  52. 52. Disadvantages: ◉ Induction of impurities due to thermal decomposition during processing- affecting long term clinical fixation ◉ Dissolution of HA at lower pH HA coating on the implant surface (50-70µm) by various methods 1. Plasma spraying 2. The vacuum deposition technique(ion beam sputtering, radiofrequency sputtering) 3. The sol gel and dip coating method 4. Electrolytic process
  53. 53. Nanotitania coatings ◉Nanotitania coatings were prepared by using the sol-gel technique ◉Nanotitania implants had an increased feature density and a large feature coverage area as compared to the nano-HA implants. ◉This could present more binding sites for the protein cell attachment and for increased bone contact ◉he Nanotitania implants exhibited an ordered arrangement, forming a homogenous layer on underlying topography
  54. 54. Biologically active drugs incorporated dental implants ◉Bisphosphonates :Bisphosphate-loaded implant surfaces have been reported to improve implant osseointegration. ◉Simvastatin: ◉Simvastatin, could induce the expression of bone morphogenetic protein (BMP) , mRNA that might promote bone formation and increase bone mineral density ◉Gentamycin along with the layer of HA can be coated onto the implant surface which may act as a local prophylactic agent along with the systemic antibiotics in dental implant surgery
  55. 55. Biochemical Methods of the Surface Modifications
  56. 56. Biochemical Methods of the Surface Modifications ◉Their goal is to immobilize proteins, enzymes or peptides on biomaterials for the purpose of inducing specific cell and tissue responses, 1. One approach uses cell-adhesion molecules like fibronectin, vitronectin, Type I collagen, osteogenin and bone sialoprotein 2. The second approach uses biomolecules with osteotropic effects which range from mitogenicity (interleukin growth factor-I, FGF-2, platelet derived growth factor –BB) to the increasing activity of the bone cells, which enhances the collagen synthesis for osteoinduction
  57. 57. Zirconia implants Zirconia (Zr02) is a ceramic material used in implantology because: ◉Biocompatibility(bio inert) ◉Esthetics (because its colour is similar to the teeth), and ◉ Mechanical properties, which are better than alumina. ◉High resistance to corrosion, flexion, and fracture ◉Contact with bone and soft tissue similar to that observed in titanium implants ◉It can be used to produce a entire implant or as a coating.
  58. 58. Advantages of Zirconia Dental Implants ◉No dark colour of the metal showing through the gums ◉No corrosion of the zirconia as with titanium ◉No piezo-electric currents between dissimilar metal in the mouth ◉It is thermally non-conductive ◉Greater BIC (Bone – Implant Contact) ◉20% more bone apposition than titanium implants Zeynep O¨ zkurt ,Zirconia Dental Implants: A Literature Review Journal of Oral Implantology Vol. 37(3)2011
  59. 59. ◉RTQ (removal torque testing): Gahlert et al evaluated the RTQ values of machined zirconia implants, sandblasted zirconia implants, and SLA titanium implants. The mean RTQ for machined zirconia implants was 25.9 N/cm, the mean RTQ for zirconia rough implants was 40.5 N/cm, and the mean RTQ for SLA titanium implants was 105.2 N/cm ◉Fracture strength : within clinically acceptable limits ◉Stress analysis: . Kohal et al observed the stress distribution patterns of zirconia implants (ReImplant), which were found to have low, well distributed, and similar stress distribution compared with titanium implants
  60. 60. PEEK implants (poly etheretherketone) ◉These implants are available in three fundamentally different designs; ◉TAU : Diameter -4..8 mm ; lengths :10 , 12.5 ,15 mm immediate loading possible Low density bone ◉THETA : Similar to TAU but D1 bone ◉IOTA : It is a 3mm diameter implant (10 and 12 mm) used in narrow ridges
  61. 61. Advantages: ◉Good strength,fracture resistance and bioinertness ◉Promotes human oseteoblast cell growth Disadvantages: ◉Faintly radiopaque –difficult for post-op evaluation ◉Lengths and diameters range is restricted
  62. 62. Advances in commercially available implant systems
  63. 63. LASER- LOK TECHNOLOGY ◉Unique surface characteristics ◉Laser-Lok microchannels is a series of cell-sized circumferential channels that are precisely created using laser ablation technology. ◉Extremely consistent microchannels that are optimally sized to attach and organize both osteoblasts and fibroblasts. ◉ Includes a repeating nanostructure that maximizes surface area and enables cell pseudopodia and collagen microfibrils to interdigitate with the Laser-Lok surface.
  64. 64. Biologic response : ◉The inhibition of epithelial downgrowth and the attachment of connective tissue (unlike Sharpey fibers). ◉This physical attachment produces a biologic seal around the implant that protects and maintains crestal bone health. ◉More effective than other implant designs in reducing bone loss. ◉The Laser-Lok surface has been shown in several studies to offer a clinical advantage over other implant designs to reduce bone loss by 70% .
  65. 65. NobelReplace™ Tapered Groovy implant ◉NobelReplace™ Tapered Groovy implant is shaped to resemble a tooth root. ◉New and unique grooved threads ◉ Since bone forms more rapidly in the grooves, the Groovy implants integrate faster ◉Tapered design makes surgical procedure exceptionally simple and predictable – especially for immediate placement after extraction.
  66. 66. Indications ◉For immediate placement after extraction. ◉Whenever immediate or early loading is applied. Advantages of groove pattern ◉Faster integration with grooves ◉Bone formed preferentially within the grooves, compared to other parts of the implant ◉Enhanced osseoconductive properties of the grooves and a guiding effect on bone forming cells ◉Up to 30% increase in stability
  67. 67. The NobelSpeedy™ implant Features: ◉Parallel walled implant ◉Slightly tapered design ◉TiUnite® surface provides accelerated osseointegration over machined surface implants . ◉Narrow tip makes it perfect for flapless surgery ◉ Primary stability at time of implant placement. ◉Shortening treatment time and speeding recovery
  68. 68. ◉The innovative implant tip is sharp so the implant works as an osteotome. ◉This feature allows variable, and if needed, extensive under- preparation of the site. ◉The resulting higher initial stability, especially in soft bone, supports immediate function. ◉The sharp tip also secures a smooth insertion ◉It provides the possibility to increase torque and place the implant further down without repeating the drilling procedure
  69. 69. NobelSpeedy™ Replace ◉Narrow Tip ,Sharper Chamfers ◉Internal Abutment Connection ◉Slightly Tapered ◉TiUnite® all the way up ◉Extremely Short Drill Protocol ◉Grooves on threads ◉Increased initial stability in soft bone
  70. 70. NobelSpeedy™ Groovy ◉Same benefits as NobelSpeedy™ Replace. In addition: ◉External Abutment Connection ◉Including Shorty implant NobelSpeedy™ Shorty (7mm)
  71. 71. NobelActive™ Implant ◉NobelActive™ implants do not cut through bone like conventional implants, they gently press through it like a corkscrew. ◉This bone condensing capability delivers high initial stability. ◉The narrow neck is designed to preserve marginal bone and promote long-lasting soft tissue stability. ◉The self-drilling ability of NobelActive™ implants allows it to be inserted into sites prepared to a reduced depth
  72. 72. ◉This is useful where sites are close to vital anatomical structures: the mandibular nerve canal or the maxillary sinus, and nose cavity. ◉Immediate placement in the esthetic region, even when buccal bone plate is very thin ◉Excellent stabilization in wide sockets
  73. 73. NobelPerfect™ ◉NobelPerfect™ is a unique, anatomically designed implant for esthetically demanding areas from premolar to premolar. ◉The interproximal bone may be preserved in situations where the three-dimensional ridge topography results in a height discrepancy between the facial and interproximal aspect of the osteotomy. ◉Scalloped soft tissue apposition area allows for the development of the biologic width around the entire neck of the implant. ◉ Scalloped prosthetic table follows three-dimensional soft tissue topography
  74. 74. The NobelPerfect™ One-Piece implant ◉The NobelPerfect™ One-Piece implant is machined from a single piece of titanium. ◉The scalloped TiUnite surface contour at the implant neck follows the same principles as for the original NobelPerfect™. ◉With this design, the soft tissue is supported entirely by the implant body, irrespective of the shape of the osseous ridge.
  75. 75. NobelDirect Implant The NobelDirect Groovy implant features a revolutionary new one- piece design that is ◉User-friendly, ◉Cost-effective, ◉ Biologically sound and ◉ Esthetically stable. ◉The implant is machined from a single piece of titanium, incorporating both the implant body and an integral fixed abutment.
  76. 76. Astra Tech implant system ◉OsseoSpeed™ -chemically modified titanium surface, ◉Providing unique nano scale topography ◉Stimulates early bone healing and speeds up the bone healing process. ◉The result of the micro-roughened titanium surface treated with fluoride is increased bone formation and stronger bone-to-implant bonding.
  77. 77. MicroThread™ ◉The neck of Astra Tech implants are designed with MicroThread that has minute threads that offer optimal load distribution and lower stress values.
  78. 78. ◉Conical Seal Design™ a strong and stable fit ◉Conical connection below the marginal bone level transfers the load deeper down in the bone……. ◉Reduces peak stresses and thereby preserves the marginal bone. ◉Seals off the interior of the implant from surrounding tissues, minimizing micro-movements and micro-leakage
  79. 79. Straumann SLActive implant ◉Chemical modification to a sandblasted, large-grit, acid- etched (SLA) implant surface. ◉Hyrdophilicity ◉Protein adsorption ◉Enhanced osteoblast activity within the first weeks ◉Enhanced angiogenesis and bone healing within the first few days after contact with the new surface. ◉This surface reduced the average healing time from 12 weeks (TPS surface) to only 6-8 weeks.
  80. 80. Straumann Roxolid Implant ◉Roxolid® is a homogenous metallic alloy composed of the elements titanium and zirconium. ◉Higher tensile strength compared to pure titanium. ◉Important when small diameter implants are chosen due to their reduced size. ◉Roxolid® and SLActive® combine high strength with excellent osseointegration. ◉Roxolid® implants have been used where 3.3mm titanium implants previously were not suitable.
  81. 81. Software Simplifying Treatment Planning
  82. 82. SimPlant software ◉Surgi Guides are computer-generated drilling guides that are fabricated through the process of stereolithography. ◉The SurgiGuide concept is based on the presurgical treatment planning using SimPlant software for ideal implant positioning. ◉These successive diameter surgical osteotomy drill guides may be either bone, teeth, or mucosa-borne.
  83. 83. ◉Surgi Guides have metal cylindrical tubes that correspond to the number of desired osteotomy preparations and specific drill diameters. ◉ The diameter of the drilling tube is usually 0.2mm larger than the corresponding drill, thus making angle deviation highly unlikely.
  84. 84. NobelGuide NobelGuide is a complete treatment concept for ◉Diagnostics, ◉ Prosthetic-driven treatment planning and ◉Guided implant surgery – for a single missing tooth to an edentulous jaw.
  85. 85. NobelClinician Software ◉NobelClinician Software is the next generation software for Digital diagnostics and Treatment planning. ◉Through various pre-defined workspaces any DICOM file can be reviewed and analyzed. ◉It combines a patient's detailed clinical information with 3D radiographic data into a sophisticated virtual environment.
  86. 86. CAD/CAM in implant dentistry Uses ◉Used in designing of prosthesis ◉Used in milling /fabrication of prosthesis(framework) ◉For milling of abutments. Advantages: ◉Superior fit ◉Less degree of rotational freedom so more accurate implant abutment connection.
  87. 87. CAD/ CAM system Provider Implant restoration type Restoration material Procera Nobel Biocare Abutments Fixed partial denture frameworks Milled bars Titanium Alumina Zirconia Atlantis Astra Tech Abutments Titanium Titanium with gold coating Zirconia Encode Biomet 3i Abutments Titanium Titanium with gold coating
  88. 88. CAM StructSURE Biomet 3i Milled bars Titanium CARES Straumann Abutments Titanium Zirconia Etkon Straumann Frameworks Abutments Zirconia Titanium BioCad BioCad Medical Abutments Milled bars Titanium
  89. 89. Recent advances in Implant Abutments
  90. 90. Angled abutments ◉Used to improve the path of insertion of prosthesis or final esthetic result ◉Fabricated in 2 pieces - so weaker in design ◉Implant placed at an angle requires angled abutment ◉Inclination range from 10-350 ◉Has 12 facets & 12 positions of angulation in a 3600 circle ◉Has non rotating interface with implant
  91. 91. UCLA ABUTMENT ◉Designed by JohnBeumer, Wynn Hornburg, and Peter E. Staubli ◉It fits directly on top of either the implant fixtures intraorally or the laboratory implant fixture analogues ◉It is a plastic castable sleeve. ◉Made to simplify the complicated prosthetic rehabilitation of Nobel Biocare implant. ◉This abutment is available for all implant systems
  92. 92. Advantages ◉Subgingival placement of the restoration ◉Helps with interocclusal distance limitations ◉Improved esthetics ◉More apical position only allows the emergence profile through the soft tissue and natural in appearance ◉Can be in porcelain instead of the usual titanium cylinder
  93. 93. Ceramic abutments ◉Densely sintered high-purity alumina (al2o3) ceramic ◉Yttria (Y2O3) -stabilized tetragonal zirconia polycrystal ceramics Alumina abutments : ◉Flexural strength of 400 mpa ◉ A fracture toughness value between 5 and 6 mpa ⁄ m0.5 ◉ Modulus of elasticity of 350 GPa
  94. 94. Advantages ◉Easier to prepare intraorally ◉Less whitish than zirconia abutments The problems ◉Radioopalescence at the time of radiographic examination ◉Weak resistance to fracture Zirconia abutments ◉Twice the flexural strength of alumina ceramic -900–1400 mpa ◉ A fracture toughness of up to 10 mpa ⁄ m0.5, ◉Modulus of elasticity value -210 gpa
  95. 95. Advantages : ◉Perfect aesthetics and stability ◉ Outstanding anatomical design ◉ Dual concept: titanium base / ZrO2 abutment ◉ Highest precision of fit Indications: ◉Fixed restorations, single crowns and bridgework.
  96. 96. CERADAPT ABUTMENT ◉All ceramic alternative to metal abutments ◉Pre machined precision milled abutment made to fit the implant hex - made up of densely sintered 99.8% pure aluminium oxide ◉It is a non metallic , non corrosive , bio compatible ◉Soft tissue response is excellent ◉Tooth coloured and light diffusion property ◉Used for implant supported single and multiple tooth restoration in the anterior canine and premolar regions ◉The CerAdapt abutment is a cylinder of 12 mm high and 6 mm in diameter
  97. 97. ◉Indications 1. An implant placed too superficially,resulting in exposed Ti at the buccal aspect 2. An implant with excessively buccal placement & thin peri- implant mucosa -"shining-through" effect of the Ti abutment 3. A slight disangulation of the implant, resulting in a need to correct the direction of the implant pillar to create a harmonious embrasure & anatomy of the crown restoration
  98. 98. Multi-Unit abutment ◉Serve as a one-piece abutment. ◉Available in 7 lengths for each platform, from a 1-to 9-mm collar ◉Total height of multi-unit abutment, including the gold cylinder & the unigrip prosthetic screw is 5.05 mm. ◉Allows for a disangulation of as much as 40 degrees between the long axis of the implants. ◉In situations with greater disangulation, the angulated abutment is used
  99. 99. Implant –Abutment Interface
  100. 100. External Hex Internal Hex Morse Taper •External hex-0.7mm standard hexagon •Interchangeable in regular size platform •Screw loosening •Mechanical failure •Rotational misfit •1.7-mm-deep hex below a 0.5- mm– wide, 45° bevel •Distribute intraoral forces deeper within the implant to protect the retention screw from excess loading, •Reduce the potential of microleakage •Superior strength •Tapered abutment post is inserted into the nonthreaded shaft of a dental implant with the same taper
  101. 101. Osseotite Certain, 3i Implant Innovations, ◉The internal connection implant design incorporates an audible and tactile “click” when the components are properly seated. ◉Reduces the need for radiographs ◉This internal connection design incorporates a 6-point hex and a 12-point, double-hex internal design.  The 6-point internal hex -straight abutments. The 12-point, double-hex -machined preangled abutments to correct the off-axis emergence of the implant Israel M. Finger et al The evolution of external and internal implant/abutment connections; Pract Proced Aesthet Dent 2003;15(8):625-632
  102. 102. Platform switching ◉The platform switching concept is based on the use of an abutment smaller than the implant neck ◉This type of connection moves the perimeter of IAJ to the center of implant axis. ◉It is likely that moving the IAJ inward brings out bacteria more internally and, therefore, away from the bone crest this would explain the limitation in bone resorption
  103. 103. ◉Atieh et al. (2010) conducted a systematic review on the clinical relevance of platform switching and preservation of peri-implant crest bone levels. Ten clinical studies reported a statistically significant influence of the platform switching on the maintenance of marginal bone levels. ◉Annibali et al. (2012) conducted a similar systematic review en randomized controlled trials were selected for review dated from 2007 to 2011. Six of the ten clinical studies noted a significant difference of reduced marginal bone loss around platform switching implant-abutment group versus a traditional design. José Paulo Macedo et al Morse taper dental implants and platform switching: The new paradigm in oral implantology Eur J Dent. 2016 JanMar; 10(1): 148–154.
  104. 104. New concepts in Implants
  105. 105. All on Four ◉Four implants in edentulous jaws,: two straight ;two tilted providing a secure and optimal support for a prosthetic fixed bridge (even with minimum bone volume) ◉Maximizes the use of available bone by tilting the posterior implants by up to a maximum of 45º ◉Benefits of Angled posterior implants: • Help avoid relevant anatomical structures and can be anchored in better quality anterior bone • Offer improved support of the prosthesis by reducing cantilevers • Reduce the need for bone grafting by maximizing the use of available bone
  106. 106. ◉Final restoration: • Full-arch restoration with only 4 implants • Fixed and removable final prosthetic solutions • Flexible solutions ◉Efficient Treatment Flow: • Immediately loaded for shorter treatment times and improved patient satisfaction ◉Implant Placement Accuracy • All-on-4 Guide assists with accurate placement of implants • Can be combined with computer-aided diagnostics and treatment concept NobelGuide
  107. 107. Zygoma Implants ◉Branemark developed a specific implant called the zygomaticus fixture to provide fixed solutions even when the conditions for implant insertion were poor in the posterior maxilla. ◉zygomatic implants as self-tapping screws in commercially pure titanium with a well-defined machined surface. ◉8 different lengths, ranging from 30 to 52.5 mm. ◉45 angulated head to compensate for the angulation between the zygoma and the maxilla.
  108. 108. ◉The portion that engages the zygoma, the apical two thirds, has a diameter of 4.0 mm and the portion that engages the residual maxillary alveolar process, alveolar one third, has a diameter of 4.5 mm to 5 mm. ◉Provide immediate or early loading with immediate function ◉Less morbidity, Indications ◉Severe resorption of maxilla. ◉Free-end situations in maxilla with insufficient bone height ◉Total edentulism together with reduced bone height ◉Pneumatization of maxillary sinus.
  109. 109. The most common complication was maxillary sinusitis, Other less frequent complications – ◉ Minor sinus membrane perforation ◉Gingival infections ◉Fistula ◉Lip laceration ◉Paresthesia ◉ Implant ◉Fractures of prosthesis ◉The weighted average success is 97.05%, and maxillary sinusitis was the most common complication, ranging from 1.5% to 18.42%
  110. 110. Conclusion •With the advancements in bioengineering and biomaterials fields continued effort of dedicated dental faculties, several innovation have made implant dental treatment a highly successful option for patient. •The incorporation of new tech. and by methods has improved the specific areas of conventional treatment procedures. •Continued research will determine if specific implant modification will diminish complication and improve implant serviceability additionally, future deviation in material and tech will surely improve their efficacy
  111. 111. References ◉Carl e misch contemporary implant dentistry 3 rd edition ◉Israel m. Fingerthe evolution of external and internal implant/abutment connections ; pract proced aesthet dent 2003;15(8):625-632 ◉ Eugenia candel-martı rehabilitation of atrophic posterior maxilla with zygomatic implants: review journal of oral implantology vol. Xxxviii/no. Five/2012 ◉Suraksha shrestha current concepts in biomaterials in dental implant science research. Vol. 2, no. 1, 2014, pp. 7-12. ◉ Hemlata garg et al ; implant surface modification : a review ;journal of clinical and diagnostic research. 2012 april, vol-6(2): 319-324 ◉S.Anil et al dental implant surface enhancement and osseointegration implant dentistry ;a rapidly evolving practice ◉William c. Scarfe clinical applications of cone-beam computed ◉Tomography in dental practice jcda february 2006, vol. 72, no. 1
  112. 112. ◉David gelb; clinical and radiographic evaluation of brånemark implants with an anodized surface following seventoeight years of functional loading int j dent. 2013; 2013: 583567 ◉Dental implant surface treatments using laserlok microchannels | biohorizons ◉Aishwarya nagarajan et al diagnostic imaging for dental implant therapy clin imaging sci. 2014; 4(suppl 2): 4. ◉Jack a. Hahn clinical and radiographic evaluation of one-piece implants used for immediate function journal of oral implantology; vol. Xxxiii/no. Three/2007 ◉Ralf-j. Kohal ceramic abutments and ceramic ◉Oral implants. An update periodontology 2000, vol. 47, 2008, 224– 243
  113. 113. ◉ Reham b. Osman a critical review of dental implant materials with an emphasis on titanium versus zirconia materials 2015, 8, 932-958 ◉ Puneet chopra mini dental implants-the same day implants;ijcd ;june ,2011 (3) ◉José paulo macedo et al morse taper dental implants and platform switching: the new paradigm in oral implantology eur j dent. 2016 janmar; 10(1): 148–154. ◉Mohit g kheur transitional implants: an asset to implantologyj interdiscip dentistry year : 2011 | volume : 1 | issue : 1 | page : 49 ◉Zeynep o¨ zkurt zirconia dental implants: a literature review ; journal of oral implantology vol. Xxxvii/no. Three/2011 ◉Ashu sharma; zygomatic implants/fixture: a systematic review journal of oral implantology ; vol. Xxxix/no. Two/2013
  114. 114. Thank you!