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Presentation on theme: "Disclaimer This presentation is reprinted by Cigna with the permission of its author, Dr. Thomas Taylor. The health information in this presentation is."— Presentation transcript:

1 Disclaimer This presentation is reprinted by Cigna with the permission of its author, Dr. Thomas Taylor. The health information in this presentation is provided by Cigna solely for informational purposes as a public service to promote health. It does not constitute medical advice and is not intended to be a substitute for your professional judgment. Neither Cigna, nor the author of the materials, nor the author's institution assume any responsibility for any circumstances arising out of the use, misuse, interpretation or application of any information supplied in this presentation or on this website.

2 Dental Implants: Past and Present Thomas D.Taylor, D.D.S., M.S.D. UConn School of Dental Medicine Effective December, 2011 – December, 2016

3 Objectives During this program, youll gain an understanding of: Tooth loss and its consequences The evolution of todays dental implant The importance of osseointegration and the factors that influence it The steps involved in the dental implant process Some of the many applications of dental implant therapy

4 Then and Now: A Brief History of the Evolution of the Dental Implant Tooth Loss can result from a variety of factors including: Disease Periodontal disease Dental caries Trauma Failure to develop

5 Then and Now: A Brief History of the Evolution of the Dental Implant Statistics show that 69% of adults ages 35 to 44 have lost at least one permanent tooth to an accident, gum disease, a failed root canal or tooth decay. Furthermore, by age 74, 26% of adults have lost all of their permanent teeth.- American Association of Oral and Maxillofacial Surgeons

6 Then and Now: A Brief History of the Evolution of the Dental Implant Consequences of tooth loss Nutritional Psychosocial Esthetic Physiological

7 Physiological consequences of tooth loss A healthy tooth root transfers biting forces to supporting bone and maintains its strength and integrity. When a tooth is lost, there are no longer any forces being transferred. The bone may then begin to atrophy. Adjacent teeth can begin to migrate causing additional gaps and an unsightly appearance. Then and Now: A Brief History of the Evolution of the Dental Implant

8 Physiological Consequences of tooth loss Changes in Intraoral Structure Some remaining alveolar ridge Very little remaining alveolar ridge

9 Then and Now: A Brief History of the Evolution of the Dental Implant Traditional Solutions for Tooth loss include: Fixed partial dentures Removable complete or partial dentures

10 Then and Now: A Brief History of the Evolution of the Dental Implant Fixed partial dentures can lead to Negative effects on adjacent healthy teeth Recurrent caries Periodontal disease

11 Then and Now: A Brief History of the Evolution of the Dental Implant DENTURES

12 Then and Now: A Brief History of the Evolution of the Dental Implant At best 17% as efficient as real teeth! At best 17% as efficient as real teeth!

13 Then and Now: A Brief History of the Evolution of the Dental Implant Surgical Attempts to improve the denture bearing foundation have included: Vestibuloplasty Vestibuloplasty Osteotomy Osteotomy Implantology Implantology

14 Then and Now: A Brief History of the Evolution of the Dental Implant Soft tissue surgery- vestibuloplasty

15 Then and Now: A Brief History of the Evolution of the Dental Implant Hard tissue surgery- osteotomy 1 month post surgery6 months post surgery1 year post surgery

16 Then and Now: A Brief History of the Evolution of the Dental Implant Immediately after osteotomy One year after osteotomy

17 Then and Now: A Brief History of the Evolution of the Dental Implant Dental Implants Dental Implants Until 1982 limited to anecdote and empiricism Until 1982 limited to anecdote and empiricism Premature clinical use and poor documentation Premature clinical use and poor documentation Lack of clinical trials Lack of clinical trials Lack of longitudinal results Lack of longitudinal results 1909 radiograph of iridium basket implant used to replace one tooth Archeological evidence of dental implants using whale bone or ivory From Central America

18 Then and Now: A Brief History of the Evolution of the Dental Implant Traditional dental implants can be divided into several main types, and they can be described according to their shape and how they are attached to the jaw. ENDOSSEOUS IMPLANT (within the bone) SUBPERIOSTEAL IMPLANT (on top of the bone) TRANSOSTEAL IMPLANT (through the bone)

19 Then and Now: A Brief History of the Evolution of the Dental Implant ENDOSSEOUS IMPLANT within the bone blade-shaped implants Epithelial down growth over time with blade implants Blade Implant

20 Then and Now: A Brief History of the Evolution of the Dental Implant BLADE IMPLANT FAILURE Alveolar bone Scar tissue Dental implant

21 Then and Now: A Brief History of the Evolution of the Dental Implant SUBPERIOSTEAL IMPLANTS -on top of the bone These implants consist of a metal framework that rests on top of the jawbone but underneath the gum tissue.

22 Then and Now: A Brief History of the Evolution of the Dental Implant Posts remain above the gum tissue as anchors for a prosthesis Metal framework lies on top of the mandible Subperiosteal Implants

23 Then and Now: A Brief History of the Evolution of the Dental Implant Subperiosteal Implant Failure Down growth of epithelium and exposure of the implant

24 Then and Now: A Brief History of the Evolution of the Dental Implant STAPLE OR TRANSMANDIBULAR IMPLANTS (TMI) IMPLANTS TRANSOSTEAL IMPLANTS through the bone These implants are either a metal pin or a U-shaped frame that passes through the jawbone and the gum tissue, into the mouth.

25 Then and Now: A Brief History of the Evolution of the Dental Implant Radiographic and intraoral views of a transmandibular staple implant

26 Then and Now: A Brief History of the Evolution of the Dental Implant THE MODERN ERA OF DENTAL IMPLANTOLOGY BEGAN IN 1982 AT A CONFERENCE IN TORONTO THE MODERN ERA OF DENTAL IMPLANTOLOGY BEGAN IN 1982 AT A CONFERENCE IN TORONTO

27 Then and Now: A Brief History of the Evolution of the Dental Implant Per Ingvar Brånemark, MD, PhD Per Ingvar Brånemark, MD, PhD Professor of Orthopedics University of Gothenburg

28 Then and Now: A Brief History of the Evolution of the Dental Implant Radiograph of one of the first human titanium implants placed in 1965 Titanium dental implant in the jaw of a dog

29 Then and Now: A Brief History of the Evolution of the Dental Implant OSSEOINTEGRATION Direct contact, at the light microscopic level, between the implant surface and vital bone in a functionally loaded implant. Also called functional ankylosis (Schroeder). Direct contact, at the light microscopic level, between the implant surface and vital bone in a functionally loaded implant. Also called functional ankylosis (Schroeder). Alveolar bone Implant Direct contact at the light microscopic level

30 Then and Now: A Brief History of the Evolution of the Dental Implant Titanium Highly corrosion resistant Lightweight metal Conducive to osseointegration

31 Then and Now: A Brief History of the Evolution of the Dental Implant

32 Tooth root replacement Bone forms a bond with the dental implant The implant functions like a natural tooth and is biocompatible The implant fuses to bone – should be permanent The implant is resistant to infection (periodontal disease) Implants are usually shaped like a screw or cylinder and are made either of metal, metal covered with ceramic, or ceramic material.

33 What factors influence implant Osseointegration? Implant design Host site Surgical technique

34 Implant Design Implant diameter The diameter of most implants falls within the range of 3.25 to 6 mm. Larger diameter implants may be used in posterior areas of the mouth and where there is poor bone quality. Implant length Research shows that various lengths of implants can be used ranging from 6 to 15 mm. Its good practice to use the longest implant that can be safely placed.

35 Implant Design Abutments are divided into two types Prefabricated abutments These are made by the manufacturer of the implant and can be modified by the restorative dentist as needed. Custom abutments These are fabricated by a dental lab using CAD/CAM technology similar to that used for crowns and are made for a specific patient. ABUTMENT: The component that connects the final prosthesis to the implant

36 Implant Design Porcelain Fused to Metal Crown AbutmentScrew

37 The Host Site Who is a good candidate? Overall the patient must: Have a comprehensive evaluation Be in good health Have healthy oral tissues Have adequate bone structure Demonstrate a willingness to practice home care Maintain regular dental visits Almost anyone can have dental implant surgery Areas of concern that affect wound healing: Tobacco use Uncontrolled diabetes Radiation therapy Ability to take care of the implants Overall health sufficient to undergo minor elective surgery

38 Surgical Technique Surgical Experience Operating conditions Drilling technique Healing and loading times Delayed loading – 6-8 weeks post surgery Early loading – 4-6 weeks post surgery Immediate loading – day of surgery-one week post surgery Avoid loading the implant during the 2-4 week period post- surgery (transition period between primary and secondary stability)

39 What are the risks and benefits? BENEFITS Dental implants can replace teeth without involving adjacent natural teeth Dental implants help prevent bone resorption Dental implants eliminate the problem of ill-fitting dentures and subsequent irritation Clinically proven success rate of over 90% Implants look natural and healthy RISKS Bleeding Infection Failure to osseointegrate (very rare)

40 Who Should Place Implants? Implant treatment may be provided in several ways: Implants can be placed by a team of dental professionals. This might include an oral surgeon or a periodontist who performs the surgical procedures, and a prosthodontist or a general dentist who fabricates the prosthesis over the implant. Prosthodontists now receive training in the placement of implants during their residency. A dentist who has had extensive dental implant and associated training and limits his or her practice to implants may perform both the surgery and fabricate the prosthesis over the implant A general dentist possessing the required knowledge, skills, and training may include implant procedures in his or her practice and perform all the procedures. A team approach to treatment is generally preferred for more complex implant cases.

41 Types of Prostheses over Implants Partially Edentulous Cases Restored with single crown or fixed partial denture restorations Cemented or Screw retained design Porcelain fused to metal Completely Edentulous Cases Restored with fixed or removable restorations Fixed Porcelain fused to metal bridge design Hybrid design Removable Similar design to traditional dentures except containing attachments to supporting implants

42 What is the dental implant process? There are generally four steps involved in the dental implant process that take several months to complete Careful planning Surgical placement of the implant body Followed by 6-8 weeks of healing and osseointegration Attachment of the abutment (if used) Placement of the final restoration

43 Step 1: Careful Planning Careful assessment of the patients oral and overall health Address any patient questions and concerns Radiographs Diagnostic casts Other tests

44 Step 2: Surgical Placement of Implant

45 Single Implant placement The dentures of an edentulous patient can be lined with a soft material and placed back in patients mouth after implants are placed.

46 Step 2: Surgical Placement of Implant Healing cap

47 Step 3: Attachment of Abutment Abutment

48 Step 3: Attachment of Abutment

49 Step 4: Placement of Restoration Crown Restoration

50 Step 4: Placement of Restoration Aftercare

51 Other Applications: Fixed Partial Denture

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54 Other Applications: Implant Supported Overdenture O-Ring or Stud Retained Overdenture And Bar-Clip Type Overdenture

55 Other Applications: Implant Supported Overdenture Initial placement After healing Non-splinted implants will support an overdenture

56 Other Applications: Implant Supported Overdenture Removal of the healing caps reveals the implant bodies Ball-shaped attachments (abutments)

57 Other Applications: Implant Supported Overdenture

58 Impressions are taken to properly fit the overdenture

59 Other Applications: Implant Supported Overdenture Stud recipient sites

60 Other Applications: Implant Supported Overdenture

61 Other Applications: Fixed Denture

62 Abutment posts Small spaces allow for cleaning the prosthesis and abutment posts Hybrid design

63 Other Applications: Fixed Denture

64 Other Applications: Fixed Prostheses Radiograph and intraoral images of a patient with a failing maxillary fixed restoration and removable partial denture.

65 Other Applications: Fixed Prostheses Surgically placed implants in the maxilla and mandible

66 Other Applications: Fixed Prostheses 4 anterior and 4 posterior implants were placed in the maxilla 4 posterior implants were placed in the mandible

67 Other Applications: Fixed Prostheses Impression copings were used to make the master impression A temporary bridge was also used during the healing process Impression copings Temporary bridge

68 Other Applications: Fixed Prostheses An implant level Impression was made of the maxillary arch. Implant replicas were then attached to the impression copings A stone cast was then made from the impression.

69 Other Applications: Fixed Prostheses The master working cast with the abutments in place was used to fabricate the final fixed prosthesis

70 Other Applications: Fixed Prostheses The prostheses were fabricated on the master working casts and then placed in the patients mouth to confirm fit, function and appearance.

71 Other Applications: Fixed Prostheses Final fixed prosthesis in the maxilla The result is a secure and natural looking dentition

72 Other Applications: Fixed Prostheses

73 Other Applications: Ectodermal Dysplasia

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80 Bar-clip type overdenture

81 Other Applications: Ectodermal Dysplasia

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84 Conclusion You have now completed a review of the following topics as stated at the beginning of the program: Tooth loss and its consequences The evolution of todays dental implant The importance of osseointegration and the factors that influence it The steps involved in the dental implant process Some of the many applications of dental implant therapy Questions regarding the course material can be directed to: Dr. Thomas D. Taylor at TTAYLOR@uchc.edu.TTAYLOR@uchc.edu

85 Thank you for completing the Dental Implant Course. In order to receive credit for completing this course you must complete a 10 question, multiple choice test and receive a passing score of 80% or higher. You will have an unlimited number of attempts to take the test. Please copy and paste or click on the link below which will redirect you to the test. Please note that it may take up to 10 seconds for the test to begin. https://cignaforhcp.cigna.com/app/provider/help/BUDCS0082a_web/player.html


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