لثة \ خامس اسنان د. زيد م(3) 3\ 4\ 2017 366 Dental implant

Dental implant Is a non-biologic (artificial) device surgically inserted into the jaw bone to Replace a missing teeth Provide support for a prosthetic denture

Component of endosseous dental implant Implant fixture Transgingival abutment post Dental prosthesis

Component of endosseous dental implant Implant fixture: which is the portion of the Implant that is surgically placed into bone that act as a root &needs 3-6 m. to be fully supported .by bone

2.Transgingival abutment post is a titanium post that protrudes through tissue into mouth &support restorative prosthesis(crown or denture) to fixture. 3.Fixed or removable dental prosthesis which can be either fixed restoration (prosthetic crown)or removable (denture prosthesis).

Healing of endosseous dental implant Osseointegration of the fixture (Bone cells grow around fixture until bone is in close contact with surface of fixture) Perimucosal seal (the epithelium adapts to transgingival post creating biological seal)

Tissues that surround implant Peri-implant tissue Tissues that surround implant are similar to periodontium of natural tooth but there are some important differences

Peri-implant tissue Connective tissue fiber inserted to the root surface while in peri-implant tissue the fiber parallel or circular to implant surface No periodontal ligament in peri-implant tissue No cementum in peri-implant Direct contact of alveolar bone

Implant to Epithelial tissue interface Epithelial cells adhere to Implant surface via hemidesmosomes (theoretically) Junctional Epithelium form biological seal that function as a barrier b/w Implant & oral cavity

In natural teeth Gngival fibers brace Gingival margin against tooth & strengthen attachment of Junctional Epithelium to tooth while periodontal ligament suspends tooth in its socket.

Periodontal ligament serve as a physical barrier to bacterial invasion So lack of such protective function in Implant allow organisms to destroy bone much more rapidly.

Implant to bone interface Osseointegration is direct contact of bone with Implant surface Clinically, osseointegration is regarded as successful if there is : 1- absence of clinical mobility. 2- absence of inflammation of peri implant tissue. 3- no discomfort or pain when Implant is in function. 4- no increased bone loss or radiolucency around Implant on radiograph.

Pathological changes in peri-implant tissues Plaque deposits Can accumulate on Implant & result in inflammation of soft tissue around Implant when disease process progresses further, partial or total loss of osseointegration can occur. That is subdivided into:

Pathological changes in peri-implant tissues Peri-implant gingivitis gingivitis without bone loss Peri-implantitis associated with bone

Peri implantitis Begins at coronal portion while apical portion continues to be osseointegrated Advanced lesion could be detected as bone loss around Implant Implant does not become mobile until final stages of peri-implantitis.

Etiology of peri-implant disease Bacterial infection Biomechanical force smoking

Bacterial infection the pathogenesis in peri implant tissue & periodontal lesions in natural dentition progresses in Similar fashion (interaction). Rate of tissue destruction tend to be more rapid in peri implant tissue

Biomechanical factors Excessive biomechanical forces have been suggested to induce bone stress & micro# at bone-Implant interface resulting in loss of osseointegration.

Long term success of implant Self-care education regarding implant care& home care tools. Soft tissue & radiographic examination checking occlusion Demonstration on use of home care tools.

Maintenance therapy Maintenance of the bone support X-ray evaluation at specific time intervals Compare the hight & density with previous radiogragh

evaluated by long-cone paralleling technique at specific time intervals

Maintenance therapy Control of inflammation Personal & professional plaque control Evaluate & reinforce the personal plaque control each visit Maintenance of functional implant Check the implant component(as loose screws, cement washout ,material wear) screw or abutment # & proper adaptation. Mobility require immediate consultation.

Debridment of the implant use of metal, sonic ultrasonic curette contraindication. implant made of titanium that permanent damaged if treated with metal instrument Such damage is plaque retentive Metal instrument disturb surface coating implant that is decrease biocompatibility.

plastic instrument most commonly used

Peri-Implant probing Baseline data should be present regarding fixed reference point for probing

Probing should be avoided until about 3months after abutment connection. Only light pressure applied during probing as heavy force could penetrate weakly adhered biological seal & introduce organisms into peri-implant environment.

Successful Implant generally allow probe penetration of approximately 3mm