口腔种植学

Dental implantation

History and Development of Dental implant Previous non-integrating forms of implants may have been anchored to bone by means of a surrounding sheath of pseudoperiodontal ligament, but this fibrous sheath was a poorly differentiated layer of scar tissue.

In most cases, loading and gradual widening of this led to loosening of the implant and subsequent implant failure.

Implants consist of three main parts.

The three components include Implant,abutment and superstructure.

Most contemporary dental implants are made of commercially pure titanium, which has been shown to have excellent biocompatibility.

Titanium is a light metal.

When exposed to air, a surface oxide is rapidly formed.

This layer of oxide determines the biological response.

Commercially pure titanium is also highly resistant to corrosion.

Implants

Other metals have been used for osseointegration, including zirconium, gold and

titanium-aluminium-vanadium alloys.

These alloys may strengthen the implant but have been shown to have relatively poor bone-to-implant contact.

Implants

Implant design has a great influence on the stability and subsequent function of the implant in bone.

The main parameters are implant shape, implant length, implant diameter and surface characteristics. Implants

Root-form implants, such as screws and cylinders, are the dominating implant designs todays.

Screw implants are considered to be superior to cylindrical ones in terms of initial stability and resistance to compression and tension stresses under loading .

Abutment

A dental abutment is typically a machined or

custom-made component that connects the final prosthesis to the implant. The abutment may be made from a variety of materials.

A machined abutment is typically manufactured from titanium, gold or ceramic.

The advantages are that it is simple to use, requires minimal chairside and laboratory time and has a predictable precision fit and good retention. Abutment

A customised abutment may be prepable, custom-made in the laboratory or computer-aided

design-computer-aided manufacture(CAD-CAM) designed.

A prepable abutment is generally supplied by the manufacture as a blank in titanium or ceramic to be modified by the clinician at the chairside or by the dental technician on the master model.

Abutment

Customisation in the laboratory typically involves waxing to the required design and casting.

A CAD-CAM-designed abutment is produced with specialised computer software and a milling machine.

Abutment

The selection and use of an abutment is determined by a number of factors, including implant angulation and orientation, depth of soft tissue from implant body to gingival cuff, aesthetic demands, interocclusal space and preference for a cement or screw-retained prosthesis.

Superstructure

A final prosthesis

It may be connected to the implant

There are several ways to connect the final prosthesis to the implant:

screw retained direct to the implant;

Screw retained to the abutment;

Lateral/horizontal screw retained to abutment; Cement retained to abutment

Patient Assessment and Treatment-Planning

Clinical Assessment

The first part of the assessment

To define the patient’s requirements and expectations. Unrealistic expectations need to be identified and discussed.

particularly important

when significant hard and soft tissue has been lost. when the placement of multiple implants is critical to a successful aesthetic outcome.

Medical History