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Dental implants and biomaterials

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A dental implant (also known as an endosseous implant or fixture) is a surgical component that interfaces with the bone of the jaw or skull to support a dental prosthesis such as a crown, bridge, denture, facial prosthesis or to act as an orthodontic anchor. The basis for modern dental implants is a biologic process called osseointegration where materials, such as titanium, form an intimate bond to bone.
We are going to discuss the four Biomaterials and their Dental Applications, the Advantages and Disadvantages of each Material.

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Dental implants and biomaterials

  2. 2. INTRODOCTION  A dental implant (also known as an endosseous implant or fixture) is a surgical component that interfaces with the bone of the jaw or skull to support a dental prosthesis such as a crown, bridge, denture, facial prosthesis or to act as an orthodontic anchor. The basis for modern dental implants is a biologic process called osseointegration where materials, such as titanium, form an intimate bond to bone.  We are going to discuss the four Biomaterials and their Dental Applications, the Advantages and Disadvantages of each Material. DENTALS IMPLANTS AND BIOMATERIALS 2
  3. 3. COMPOSITES AS DENTAL IMPLANTS  Composites (more than One Constituents) have a lot of Dental Applications. The Predominate Application is Dental filling. A composite filling is a natural tooth coloured filling used to restore cavities or chipped teeth. Any decay will be removed, and the filling material is placed into the cavity in layers, a light is then used to set each layer. The filling is then shaped, so that it looks realistic and does not interfere with your bite or the way you chew. It should feel smooth and comfortable immediately.  Composite fillings are not however recommended in all situations for example a back tooth with a large cavity. A composite filling may not be strong enough to withstand the heavy forces placed onto back teeth during chewing. DENTALS IMPLANTS AND BIOMATERIALS 3
  5. 5. ADVANTAGES OF COMPOSITE FILLINGS:  Aesthetics -- the shade/color of the composite fillings can be closely matched to the color of existing teeth. Composites are particularly well suited for use in front teeth or visible parts of teeth.  Bonding to tooth structure -- composite fillings actually chemically bond to tooth structure, providing further support.  Versatility -- in addition to use as a filling material for decay, composite fillings can also be used to repair chipped, broken, or worn teeth.  Tooth-sparing preparation -- sometimes less tooth structure needs to be removed compared with amalgam fillings when removing decay and preparing for the filling.Composite Fillings (White Fillings) DENTALS IMPLANTS AND BIOMATERIALS 5
  6. 6. DISADVANTAGES OF COMPOSITES FILLING  Moderate occurrence of tooth sensitivity; sensitive to dentist’s method of application .  Costs more than dental amalgam  Material shrinks when hardened and could lead to further decay and/or temperature sensitivity  Requires more than one visit for inlays, veneers, and crowns  May wear faster than dental enamel  May leak over time when bonded beneath the layer of enamel DENTALS IMPLANTS AND BIOMATERIALS 6
  7. 7. CARAMICS DENTAL IMPLANTS  Ceramics are nonorganic, nonmetallic, nonpolymeric materials manufactured by compacting and sintering at elevated temperatures. They can be categorized according to tissue response as: • Bioactive: Bioglass/Glass ceramic • Bioresorbable: Calcium phosphate • Bioinert: Alumina, zirconia and carbon.  Ceramics were introduced for surgical implant devices because of their inertness to biodegradation, high strength and physical characteristics, such as minimal thermal and electrical conductivity with a wide range of material specific elastic properties. Ceramics are chemically inert, care must be taken in handling and replacement due to its low ductility and inherent brittleness has resulted in its limitations.  A good example of Ceramics that has Dental Application is Zirconia (Artificial Diamond), which is Hard and Allotropic in Nature.  Porcelain is another Ceramic with Dental Application. It is a glass-like material formed into fillings or crowns using models of the prepared teeth. The material is tooth- colored and is used in inlays, veneers, crowns and fixed bridges. DENTALS IMPLANTS AND BIOMATERIALS 7
  8. 8. ADVANTAGES OF CERAMICS DENTAL IMPLANTS  Good resistance to further decay if the restoration fits well.  Is resistant to surface wear but can cause some wear on opposing teeth.  Resists leakage because it can be shaped for a very accurate fit.  The material doesn’t cause tooth sensitivity. DENTALS IMPLANTS AND BIOMATERIALS 8
  9. 9. DISADVANTANGES OF CERAMICS AS DENTAL IMPLANTS  Material is brittle and can break under biting force.  May not be recommended for molar teeth.  Higher cost because it requires at least two office visits and laboratory services. DENTALS IMPLANTS AND BIOMATERIALS 9
  10. 10. METALS AS DENTALS IMPLANTS  Most dental implants are made of titanium, a metal that has special qualities that make it useful for this purpose. Titanium develops a thin film on its surface that protects it from corrosion. It is resistant to acids, salt solutions and oxygen, among other things. Titanium also is almost completely nonmagnetic and is extremely strong for its weight. Perhaps most important, the body does not reject titanium implants as foreign objects. When implants are placed in bone, the bone grows around the implant in a process called osseointegration.  Gold Alloy, a gold-Colored mixture of Gold, Copper and other metals is used mainly for crowns and fixed bridges and some partial denture frameworks.  Metals like Gold and Silver are used in Dental Filling DENTALS IMPLANTS AND BIOMATERIALS 10
  11. 11. A bridge of teeth can be supported by two or more implants. Individual teeth were replaced with implants where it is difficult to distinguish the real teeth from the prosthetic teeth. Movement in a lower denture can be decreased by implants with ball and socket retention. DENTALS IMPLANTS AND BIOMATERIALS 11
  12. 12. ADVANTAGES OF METAL DENTAL IMPLANTS  Durability -- lasts at least 10 to 15 years and usually longer; doesn't corrode  Strength -- can withstand chewing forces  Aesthetics -- some patients find gold very pleasing to the eyes.  Resists Leakage because they can be shaped for a very accurate fit.  They do not cause tooth Sensitivity (they are Biocompatible). DENTALS IMPLANTS AND BIOMATERIALS 12
  13. 13. DISADVANTAGES OF METAL DENTAL IMPLANTS  Gold is very expensive  Additional office visits -- requires at least two office visits to place  Aesthetics -- most patients dislike metal "colored" fillings and prefer fillings that match the rest of the tooth.  Conducts heat and Cold; may irritate Sensitive teeth. DENTALS IMPLANTS AND BIOMATERIALS 13
  15. 15. POLYMERS AS DENTALS IMPLANTS Polymers like Polymethyl methacrylate (PMMA), Polyamides and Poly(Zn acrylate are used for Dental fillings and prosthesis. These polymers are strong, as a Result they are Stable and have high resistance to corrosion and fatique. The more inert polymeric biomaterials include polytetrafluroethylene (PTFE), polyethyleneterephthalate (PET), polymethylmethacrylate (PMMA), ultra high molecular weight polyethylene (UHMW-PE), polypropylene (PP), polysulfone (PSF) and polydimethyl siloxane (PDS) or silicone rubber (SR).  In general, polymers have lower strengths and elastic moduli, and higher elongation to fracture compared with other class of biomaterials. They are thermal and electrical insulators, and when constituted as a high molecular weight system without plasticizers, they are relatively resistant to biodegradation compared with bone; most polymers have lower elastic moduli with magnitudes closer to soft tissues. DENTALS IMPLANTS AND BIOMATERIALS 15
  16. 16. ADVANTAGES OF POLYMERS IN DENTAL APPLICATIONS  Low Allergecity  Resistance to corrosion and fatigue  Good Adhesion with tissues  High Strength and Stability DENTALS IMPLANTS AND BIOMATERIALS 16
  17. 17. DISADVANTAGES OF POLYMERS AS DENTAL IMPLANTS  In general, polymers and composites of polymers are especially sensitive to sterilization and handling techniques. If intended for implant use, most cannot be sterilized by steam or ethylene oxide.  Most polymeric biomaterials have electrostatic surface properties and tend to gather dust or other particulate if exposed to semiclean oral environments.  Because many can be shaped by cutting or auto- polymerizing in vivo (PMMA), extreme care must be taken to maintain quality surface conditions of the implant.  Porous polymers can be deformed elastically, which can close open regions intended for tissue ingrowth.  Also, cleaning the contaminated porous polymers is not possible without a laboratory environment. DENTALS IMPLANTS AND BIOMATERIALS 17
  18. 18. CONCLUSION  Dental implantology is an exciting treatment concept that includes series of surgical, prosthetic and periodontal restorative skills  Success or failure of implants depends on the health of the person receiving it, drugs which impact the chances of osseointegration and the health of the tissues in the mouth. The amount of stress that will be put on the implant and fixture during normal function is also evaluated.  The final prosthetic can be either fixed, where a person cannot remove the denture or teeth from their mouth or removable, where they can remove the prosthetic. In each case an abutment is attached to the implant fixture. Where the prosthetic is fixed, the crown, bridge or denture is fixed to the abutment with either lag-screws or cement. Where the prosthetic is removable, a corresponding adapter is placed in the prosthetic so that the two pieces can be secured together. DENTALS IMPLANTS AND BIOMATERIALS 18
  19. 19.  The risks and complications related to implant therapy are divided into those that occur during surgery (such as excessive bleeding or nerve injury), those that occur in the first six months (such as infection and failure to osseointegrate) and those that occur long-term (such as perri-implantitis and mechanical failures). In the presence of healthy tissues, a well integrated implant with appropriate biomechanical loads can have long term success rates of 93 to 98 percent for the fixture and 10 to 15 year life spans for the prosthetic teeth DENTALS IMPLANTS AND BIOMATERIALS 19
  20. 20. REFERENCES 1. Misch CE. Contemporary Implant Dentistry (2nd ed). Mosby, St Louis, USA 1999:271-302. 2. Weiss CM, Weiss A. Principles and practice of implant dentistry (1st ed). Mosby, St Louis, USA 2001:28-46. 3. Garcia DA, Sullivan TM, O’Neill DM. Biocompatibility of dental implant material measured in animal model. J Dent Res 1981;60(1):44-49. 4. Tschernitschek, et al. Non-alloyed titanium as a bioinert metal—A review. Quintessence Int 2005;36:523-30. 5. Polymer Biomaterial (Lecture Note) Asso. Prof. Terlin Adali Department of Biomedical Engineering, Near East University. 6. Wang R, Fenton A. Titanium for prosthodontic applications: A review of the literature. Quintessence Int 1996;27:401-08. 7. Renner AM. The versatile use of titanium in implant prosthodontics. Quintessence Dent Technol 2001:188-97. DENTALS IMPLANTS AND BIOMATERIALS 20