The document discusses various factors related to dental implants including bone density, implant placement protocols, loading protocols, and implant success factors. Bone density directly impacts implant success, and there are four types of bone. Implant placement can be immediate, early, or delayed and loading can be immediate, early, or delayed depending on factors like primary stability, soft tissue healing, and bone quality. Key considerations for placement and loading protocols include esthetics, function, surrounding soft tissues and bone structure, and primary versus secondary stability.

2. Bone density

3. Bone density
• Directly related to implant successes
• Four types of bone were identified
• Progressive loading change the amount of
bone density around the dental implants

4. Etiology of variable bone density
• Do you remember Wolff ?
• The mandible Vs. maxilla
• Bone density location

8. Misch bone density classification

19. Key implant positions and number

20. Key implant positions and number
• Some implant positions are more important
than others
• The most important abutment is the terminal
abutment
• Cantilevers are force magnifiers

28. 4 golden laws of multiple implant
placement
1 •No cantilever
2 •No three adjacent pontics
3 •Canine molar rule
4 •Arch dynamics

29. No cantilever

34. No three adjacent pontics

38. Canine molar rule

45. Implant size

46. Forces applied to dental implant
shear
tension
compression

47. force
duration
magnification
direction
type

48. Length
width
Implant
surface
area

49. Long
implants
Short
implants

50. • Advantages of shorter implants
Less bone grafting in hieght
– Less time for treatment
– Less cost
– Less discomfert
Less surgical risk of
– Sinus perforation
– Paresthia
– Osteotomy truma
– Tooth damage
Surgical ease
– Decreased inter arch space
– Less inventory / less cost

51. • Implant size manipulation
Increase the diameter
Splint together
Decrease crown height
Increase implant surface area
OD VS FPD
Minimize lateral forces
Improve bone density

52. Implant diameter
Narrow Wide

53. • Surgical advantages of wide implants
– Surgical rescue implant
– Failed implant/immediate
– Tooth extraction /immediate
• Loading advantages
– Increase surface area
– Compensate for unfavorable forces
– Compensate for poor bone density
– Increase surface area for short implants

54. • Disadvantages of wide implants
Bone trauma
Decreased facial bone thickness
Stress shielding
Increased surgical failure
Damage to the adjacent tooth

55. • Implant diameter criteria
Esthetics
• Size of the tooth (minimum implant size)
• Adjacent tooth- inter proximal bone (maximum
implant size)
• Faciopalatal bone (maximum implant size)
Function
• Functional surface area
• Fatigue strength

56. Implant placement and loading
protocol

57. Implant surgery
Two stage
surgery
First stage
implant
placement
Second stage
placement of
healing abutment
One stage
surgery
The implant is
exposed from day
one

58. First stage
surgery
• Flap or
flapless
Implant
placement
• Immediate or
delayed
3 to 6
months
healing
Second
stage
surgery
• Flap or
flapless
Healing
abutment 2
weeks
Final
restoration

59. One stage
surgery
• Flap or
flapless
Implant
placement
• Immediate or delayed
placement
• Immediate or delayed loading
Healing for 3
to 6 months
• With or
without
loading
Final
restoration

63. Implant surgery
Flapless
More conservative
Better soft tissue healing
Less bone loss
More esthetic outcome
Less visibility
Risk of bone dehiscence or
fenestration
More sensitive technique
Flap elevation
More visibility
Better irrigation
Bone augmentation
Complete wound closer
Bone resorption
More healing time
Risk of flap dehiscence

92. Implant
placement
Delayed
Immediat
e
Early
Implant
loading
Delayed
Immediat
e
Early

93. Implant
placement
delayed
3 to 6 months
after tooth
extraction
Early
1 week to 2
months after
extraction
Immediate
At the same
time of tooth
extraction

94. Implant loading
delayed
3 to 6 months
after implant
placement
Early
from 2 weeks to
2 months of
implant
placement
Immediate
within 1 week of
implant
placement

95. • primary stability
achieved by direct contact between implant body
and threads with bone during implant placement.
• Secondary stability
As healing progresses, the original bone around
the implant surface remodels and areas of new
bone emerge at the implant surface. The
remodeled bone contact and new bone contact
result in secondary or biologic stability.

102. Delayed placement
Advantages
Improved
bone
structure
improved
Primary
stability
Uninterrupted
implant
healing
Soft tissue
healing
More
predictable
prosthetic
results
Disadvantages
Time consuming
Bone loss at the
extraction site
More trauma to
the bone during
preparation

103. Immediate placement
Advantages
reduce the
treatment
time
reducing the
number of
surgical
procedures
Bone
preservation
at the
extraction site
Disadvantages
risk of
infection from
residual
bacterial
poor esthetic
outcomes
unpredictable
amount of
alveolar wall
resorption

104. Earlyimplantplacement
Allow for soft tissue
healing
Placing the implant during
the bone formation phase
More esthetic results

105. delayed Loading
Advantages
Predictable
Complete
osseointegrati
on
Reduce risk of
failure
Disadvantages
Time
consuming
Less patient
satisfaction
Reduced
function and
esthetics

106. Immediate loading
Advantages
Early
restoration of
esthetic and
funtction
Reduce
treatment
time
Disadvantages
Need patient
cooperation
Complicated
technique
High risk of
faliure

107. • primary stability
achieved by direct contact between implant body
and threads with bone during implant placement.
• Secondary stability
As healing progresses, the original bone around
the implant surface remodels and areas of new
bone emerge at the implant surface. The
remodeled bone contact and new bone contact
result in secondary or biologic stability.

108. Immediate VS. delayed
• Esthetics:
esthetic recovery is more difficult in implant site
• Function:
 Anterior vs posterior
• Structure:
Soft tissue
surrounding teeth teeth
• Biology:
primary stability
Quantity and quality of bone
Pace of bone formation around the implant

110. • Esthetics: The implant site is in the esthetic
zone
• Function: The patient lacks posterior support,
deep vertical overlap (overbite) present
• Structure: Additional teeth require restoration
due to dental caries
• Biology: Thin biotype