Dr maram

• Dental implant


  A prosthetic device made of alloplastic material(s) implanted into the oral tissues beneath the mucosal and/or periosteal layer and on or within the bone to provide retention and support for a fixed or removable dental prosthesis
• Implant prosthodontics


  The branch of implant dentistry concerning with the restorative phase following implant placement and the overall treatment plan components before the placement of dental implants
• Implant prosthesis


  Dental prosthesis, such as artificial crown, fixed complete denture, fixed partial denture, removable complete overdenture, removable partial overdenture, as well as maxillofacial prothesis, which are supported and retained in part or whole by dental implants
• Classification of dental implants based on placement within tissue


  • Endosteal (endosseous) implants
  • Subperiosteal implants
  • Transosteal (transosseous) implants
• Endosteal (endosseous) implants


  • Inserted into the dentoalveolar and/or basal bone and protrude through the mucoperiosteum
  • Most common type
  • Can be used in all areas of the mouth
• Subperiosteal implants


  • Placed directly over the surface of the bone cortex and just beneath the periosteum
• Transosteal (transosseous) implants


  • Pass through the full thickness of the jaw bone, penetrating both cortical plates
  • Only used in the anterior region of the mandible in cases of severe ridge resorption
• Classification of endosseous implants according to surgical stages


  • Single-stage design (none submerged) (transgingival)
  • Two-stage design
• Classification of endosseous implants according to time of placement


  • Immediate implants (placed into a prepared extraction socket immediately following tooth extraction)
  • Early implants (placed within 4-8 weeks after the tooth loss)
  • Delayed implants (placed within 3-6 months after tooth extraction)
• Classification of endosseous implants according to time of prosthetic loading


  • Immediately loaded implants
  • Delayed loading implant (delayed loading is done in maxillary implants after 4-6 months and in mandibular implants after 3-4 months to allow for better osseointegration)
• Dental implant


  A prosthetic device made of alloplastic material(s) implanted into the oral tissues beneath the mucosal and/or periosteal layer and on or within the bone to provide retention and support for a fixed or removable dental prosthesis

  
• Implant prosthodontics


  The branch of implant dentistry concerning with the restorative phase following implant placement and the overall treatment plan components before the placement of dental implants

  
• Implant prosthesis


  Dental prosthesis, such as artificial crown, fixed complete denture, fixed partial denture, removable complete overdenture, removable partial overdenture, as well as maxillofacial prothesis, which are supported and retained in part or whole by dental implants

  
• Implant system


  Dental implant components that are designed to mate together. It consists of the necessary parts and instruments to complete the implant body placement and abutment components attachment

  
• Classification of dental implants based on placement within tissue


  • Endosteal (endosseous) implants
  • Subperiosteal implants
  • Transosteal (transosseous) implants

  
• Classification of endosseous implants according to surgical stages


  • Single-stage design (none submerged) (transgingival)
  • Two-stage design
• Classification of endosseous implants according to time of placement


  • Immediate implants
  • Early implants
  • Delayed implants
• Classification of endosseous implants according to time of prosthetic loading


  • Immediately loaded implants
  • Delayed loading implant
• Osseointegration


  The apparent direct attachment or connection of osseous tissue to an inert, alloplastic material without intervening fibrous connective tissue
• Factors affecting osseointegration


  • Surgical technique
  • Premature loading
  • Surgical fit
  • Bone quality and quantity
  • Physical condition of the patient
• Responsibilities of the prosthodontist


  • Perform the initial clinical evaluation
  • Perform the initial radiographic evaluation
  • Obtain the diagnostic casts
  • Obtain the diagnostic wax-up
  • Determine the location and number of implants and fabricate a surgical template
  • Select the proper abutment following the implant exposure
  • Design and fabricate the prosthesis
  • Provide oral hygiene care and instructions
  • Ensure recall of the patient to evaluate maintenance and provide care as required
• Responsibilities of the oral surgeon


  • Confirmation of the radiographic evaluation
  • Confirmation of the physical evaluation
  • Determination of the location and number of implants within limits set by the prosthodontist
  • Placement of the implants (first stage surgery)
  • Uncovering of the implants (second stage surgery)
  • Confirmation of osseointegration of the implants
• Indications of implant prosthesis


  • Edentulous patient with history of difficulty in wearing removable dentures
  • When there is severe change in complete denture bearing tissues
  • Poor oral muscular coordination
  • Para-functional habits that compromise prosthesis stability
  • Unrealistic patient expectations for complete dentures
  • Hyperactive gag reflex
  • Low tissue tolerance of supporting mucosa

  
• Contraindications of implant prosthesis


  • High dose irradiated patients
  • Patient with psychiatric problems such as psychosis
  • Hematological disorders
  • Pathology of hard and soft tissues
  • Patient with drug, alcohol or tobacco chewing abuse
• Implant components


  • Implant fixture (implant body)
  • Healing (cover) screw
  • Healing abutment (gingival former) (Interim abutment)
  • Implant abutment
  • Abutment screw
  • Hygiene screw
  • Transfer coping (impression coping)
  • Implant analog (laboratory analog)
  • Coping (gold cylinder)
  • Coping screw
• FP-1 fixed prosthesis


  Replaces only the crown; looks like a natural tooth

  
• FP-2 fixed prosthesis


  Replaces the crown and a portion of the root; crown contour appears normal in the occlusal half but is elongated or hyper-contoured in the gingival half
• FP-3 fixed prosthesis


  Replaces missing crowns and a portion of the edentulous site; prosthesis most often uses denture teeth and acrylic gingiva but may be porcelain to metal
• RP-4 removable prosthesis


  A removable prosthesis (overdenture) supported completely by implants (usually with a superstructure bar)

  
• FP-2 prosthesis


  Prosthesis where the available bone height has decreased by natural resorption or osteoplasty at the time of implant placement, requiring teeth that are unnatural in length to restore the excessive vertical dimension

  
• FP-3 prosthesis


  Prosthetic replacement of the soft tissue drape, most often desirable when multiple adjacent teeth are missing
• RP-4 removable prosthesis


  Removable prosthesis (overdenture) supported completely by implants (usually with a superstructure bar), rigid when inserted
• RP-5 removable prosthesis


  Overdenture supported by both soft tissue and implants (may or may not have a superstructure bar), the amount of implant support is variable
• Both screw-retained and cemented fixed implant prostheses can give excellent long-term results
• Screw-retained prostheses


  Offer the safer and most versatile option due to retrievability
• Cemented prostheses


  Precludes visibility of access openings in the occlusal or facial surfaces of the artificial teeth, but any sub-mucosal extension could predispose to peri-implant inflammation with marginal bone loss if cement remnants are not removed

  
• For full-arch prostheses, a screw-retained design is recommended as any maintenance procedure or subsequent treatment can be performed more efficiently by removing the prosthesis
• Implant impression techniques


  • Implant level impressions
  • Abutment level impressions
• Transfer (closed tray) technique

  Uses tapered copings and a closed tray to make an impression, leaving the copings intraorally
• Pick-up (open tray) technique


  Uses square copings and an open tray, allowing the coronal ends of the impression coping screw to be exposed and removed along with the impression