Implant types

TYPES OF IMPLANT
&
IMPLANT COMPONENTS
Presented by
Mujtaba Ashraf
MDS III
Department of Prosthodontics
23-07-2018Mujtaba Ashraf
1

INTRODUCTION
23-07-2018Mujtaba Ashraf 2

Dental implants are designed to provide a
foundation for replacement of teeth that look, feel,
and function like natural teeth.
Reconstruction with dental implants has
changed considerably. Rather than merely focusing
on the tooth/teeth to be replaced, today’s implant
practitioners considers a broad and complex set of
interwoven factors before formulating an implant
treatment plan. 23-07-2018Mujtaba Ashraf
3

Implant: A biocompatible alloplastic material or
device that is surgically placed into oro-facial
tissues and used for anchorage, functional,
therapeutic, and/or aesthetic purposes.
-Glossary of Implant Dentistry
Implant: Any object or material, such as an
alloplastic substance or other tissue, which is
partially or completely inserted or grafted into the
body for therapeutic, diagnostic, prosthetic, or
experimental purposes. –GPT 9
Definition
4

•The first two decades of 20th century predominated by
the clinicians namely R.E Payne & E.J. Greenfield.
•R.E. Payne presented his technique of capsule
implantation at the clinics of Third international Dental
Congress, reported in the Dental Cosmos in 1901.
•Technique- Extracting the root, enlarging the socket
with trephine, trial fitting of the capsule. He then placed
grooves on both sides of the socket & filled 2/3rd with
rubber, fitted the porcelain root into the capsule & set it,
with gutta-percha.
5

In 1913 Dr. Edward J. Greenfield came up with the surgical
method to prepare osteotomy in the healed bone using
trephine.
He fabricated the hollow cylindrical basket root of 20 gauge
iridioplatinum soldered with 24 carat gold.
• First two-piece implant, which separated the abutment
from the endosteal implant body at the initial placement.
6

GREENFIELD emphasized on the importance of
intimate contact between bone & implant.
• Hollow implants facilitated growth of bone into
implant body & secure it.
• 3 months period of unloading.
• Implants failures because of infection.
His techniques were similar to present concepts of
osteotomy preparation, restoring after healing time.
7

The modern era of implant dentistry most definitely
began in the late 1930s with the work of Venable,
Strock, Dahl, Gershkoff & Goldberg.
Venable in 1937 developed the cast Co- Cr- Mo alloy
known as Vitallium .
1937 Adams- Introduced submerged implants with
ball head screws.
In 1939 Alvin & Strock used the Venable screw type
implant .
THE DAWN OF THE MODERN ERA 1935-1978 A.D.

In 1938 Stock placed the
threaded vitallium implant into
the extraction socket, the first
long term endosseous implant. It
remained firm & asymptomatic
for nearly 17 years.
In 1947, Formiggini developed a
single helix wire spiral implants
made of stainless steel or tantalum.
Two ends of the wire were soldered
together to form a post or neck.
9

In 1950 Lee’s - design i.e central narrow post
with extensions .
In 1943 Dahl in Germany developed
Intramucosal or button implants –
Mucosal inserts
10

While conducting research into the healing patterns of
bone tissue, accidentally discovered that when pure
titanium comes into direct contact with the living bone
tissue, together to form a permanent biological
adhesion. He named this phenomenon
"osseointegration".
Professor Per-Ingvar Brånemark
began extensive experimental
studies in 1952 on the microscopic
circulation of bone marrow
healing. These studies led to a
dental implant application in the
early 1960s.
11

Brånemark System Component
Fixture
Pure titanium with machined thread
Top of the fixture has hexagonal design and
thread
The apical portion tapered with four
vertical notches
Cover screw
Seals the coronal portion of the fixture
during the interim period
Abutment
Made of titanium is the cylinder shape.
The apical portion has hexagonal shape to
fit the coronal portion 23-07-2018Mujtaba Ashraf
12

Abutment Screw– insert through the
abutment & threads into the fixture
to connect the two components .
Gold Cylinder- made of Au , Pt, Pd.
It is machined to fit the coronal
portion of the abutment. It becomes
integral part of final prosthesis.
Gold Screw –inserted through the
gold cylinder & threads into the
abutment screw to connect the gold
cylinder & abutment.
13

This concept was propagated by Dr. Charles Weiss.
According to him there is a fibro-osseous ligament formed
between the implant and the bone and this ligament can be
considered as equivalent of the periodontal ligament
found around natural teeth.
The collagen fibers are present at the bone-implant
interface and have an osteogenic effect. He advocated
early loading of the implants.
Concept Of Fibrointegration:
14

Although fibro-osseous dental implants showed initial
promise, they have been a disappointment in the long term.
Implants that are fixed in the bone socket by the growth of
connective tissue initially perform fine. But they tend to
fail over time.
When these failed implants are removed and inspected, the
collagen fibers are seen growing parallel to the implant
rather than directly into contact with it like natural
periodontal ligament.
Detractors of the fibro-osseous method of implantation
believe this simply isn’t a strong enough connection to
stand up to the forces of biting and chewing that teeth are
subjected to through the years
15

CLASSIFICATION OF IMPLANTS DEPENDING ON
Implant placement within the
tissues
Materials used
• Epiosteal
• Endosteal
• Transosteal
• Metallic implants
• Non – metallic implants
16

EPIOSTEAL IMPLANT
• It is a dental implant that receives
its primary bone support by resting
on the bone.
• So new bone will grow around the
implant.
• Example
• Subperiosteal implant
It is a dental implant structure that covers almost the entire
crestal surface of the maxillary and mandibular residual alveolar
bone under the soft tissue periosteum.
17

SUBPERIOSTEAL IMPLANTS
• An implant structure that covers the
almost entire crestal surface of
maxillary & mandibular RAR under
the soft tissue to include the
periosteum , with the four to six
posts protruding out through gingiva
and on it the complete denture will
be attached.
18

• In 1939, Strock placed first endosteal implant.
• It is a dental implant that extends into the basal bone for
support
• It transects only one cortical plate.
ENDOSTEAL IMPLANT
19

Root form Plate form
- Used over a vertical column of
bone
- Available in 3 forms
cylindrical,, screw root,
combination.
They are used for horizontal
column of bone which is flat
and narrow facial lingual
direction.
21

Cylinder root form implants depend on a coating or surface
condition to provide microscopic retention to the bone.
Most often the surface is either coated with a rough material
(e.g., hydroxyapatite, titanium plasma spray) or a macro
retentive design (e.g., sintered balls).
• Usually pushed or tapped into a prepared bone site.
• They can be a paralleled wall cylinder or a tapered implant
design
22

Screw root forms are threaded into a slightly smaller prepared
bone site and have the macroscopic retentive elements of a thread
for initial bone fixation.
They may be machined, textured, or coated.
There are three basic screw-thread geometries: V-thread, buttress
(or reverse buttress) thread, and power (square) thread designs.
Primarily available in a parallel cylinder or tapered design.
23

Combination root forms have macroscopic features from
both the cylinder and screw root forms.
As a general rule, the combination implant designs have a
press-fit surgical approach (as the cylinder implants) and a
macroscopic implant design for occlusal loads.
24

TRANSOSTEAL IMPLANTS
• A dental implant that penetrates both cortical plates and
passes through entire thickness of the alveolar bone.
25

Metallic implants
• Titanium
• Cobalt chromium molybdenum alloy
• Titanium aluminium vanadium
• Cobalt chromium molybdenum
• Stainless steel
• Zirconium
• Tantalum
• Gold
• Platinum
26

NON – METALLIC IMPLANTS
Ceramics
Carbon
27

Depending On Their Reaction With Bone
• Based on the ability of implant to stimulate bone
formation
Bio active
• Hydroxyapatite
• Tri Calcium Phosphate
• Calcium Phosphate
Bio inert
• Metals
28

IMPLANT COMPONENTS

1. Implant fixture
2. Implant mount
3. Cover screw
4. Gingival former/healing screw/healing
abutment/ permucosal extension
5. Impression post/impression transfer abutment
6. Implant analogue
7. Abutment
8. Fixation screw
Implant Components
32

IMPLANT FIXTURE
• The term fixture is used
synonymously for the implant itself
which is inserted and gets
osseointegrated with the bone.
• It works as the tooth root, and
various kinds of components are
used to cover it, make its
impression, and retain or fix the
prosthesis on top of it.
34

CREST MODULE
• The crest module of an implant body is that portion designed to
retain the prosthetic component in a two-piece implant system.
• It also represents the transition zone from the implant body
design to the transosteal region of the implant at the crest of the
ridge.
35

The abutment connection area usually has a platform
on which the abutment is seated; the platform offers
physical resistance to axial occlusal load.
An antirotation feature also is included on the platform
(external hex) or extends within the implant body
(internal hex)
36

• The crest module often is designed to reduce
bacterial invasion.
• Its smoother dimension varies greatly from one
system to another (0.5–5 mm).
• When the crest module is smooth, polished metal,
it is often called a cervical collar.
37

IMPLANT APEX
• The implant apex portion is often
tapered to permit ease of initial
placement into the osteotomy.
• An antirotational feature of an
implant may also be included,
which has flat sides or grooves
along the apical region of the
implant body or an apical hole.
38

The apical end of each implant should be flat rather
than pointed. This allows for the entire length of the
implant to incorporate design features that maximize
desired strain profiles.
39

IMPLANT MOUNT
• The implant mount is a component which usually comes
connected with the implant in its vial and it is used to carry the
implant from its vial/packaging to the prepared osteotomy site
either by hand or with a ratchet/hand piece adaptor.
Implant Fixture
Implant Mount
40

The component that is used to cover the
implant connection during the submerged
healing of the implant.
Prevent bone, soft tissue, or debris from
invading the abutment connection area
during healing.
COVER SCREW
42

GINGIVAL FORMER/ HEALING SCREW/
HEALING ABUTMENT
Used to form a healthy, aesthetic
emergence profile of the soft tissue
around the implant prosthesis.
When the implant is re-exposed
after it is osseointegrated with the
bone, the cover screw is removed
and replaced with a long gingival
former and the site is left to heal for
2 to 3 weeks.
43

• Permucosal extension
• Available in multiple heights
to accommodate soft tissue
variations.
• It also can be straight, flared,
or anatomical to assist in the
initial contour of the soft
tissue healing.
44

In the case of a one-stage surgical procedure, the
surgeon may have placed the permucosal extension at
the time of implant insertion or may have selected an
implant body design with a cervical collar of
sufficient height to be supragingival.
45

IMPRESSION POST/IMPRESSION TRANSFER
ABUTMENT
The impression post is the
component that is used to transfer
the implant Hex position and
orientation from the mouth to the
working cast.
Once the soft tissue around the
gingival former has healed, the
gingival former is removed and
impression post is inserted over the
implant. An impression is made.
46

Types of impression posts:
• Closed tray impression post
• Open tray impression post
47

CLOSED TRAY IMPRESSION POST
Poses shallow retention grooves along
its body and a short connection screw.
It is used in the closed tray impression
transfer technique.
The complete post remains under the
impression and no part of it emerges out
of the tray.
After making the impression, this post
is removed from the implant, assembled
to the analogue, and inserted to the
impression with the same orientation.
48

OPEN TRAY IMPRESSION POST
Poses deep retention grooves
along its body and a long
connection screw.
This post is used in the open
tray impression transfer
technique.
A part of its long screw
emerges out of the impression
tray, and should be unscrewed
before removing the impression
from the mouth.
50

IMPLANT ANALOGUE
Implant analogue is a
component which has a different
body but its platform and
connection are exactly similar to
the implant.
The analogue is used to
replicate the implant platform
and connection in the laboratory
mode.
52

Prosthetic Attachments

The abutment is the portion of the implant that supports
or retains a prosthesis or implant superstructure
A superstructure is defined as a metal framework that
attaches to the implant abutment(s) and provides either
retention for a removable prosthesis.
55

Three main categories of implant abutments are described, according
to the method by which the prosthesis or superstructure is retained to
the abutment:
(1) an abutment for screw retention uses a screw to retain the
prosthesis or superstructure
(2) an abutment for cement retention uses dental cement to retain the
prosthesis or superstructure
(3) an abutment for attachment uses an attachment device to retain a
removable prosthesis
56

Each of the three abutment types may be further
classified as straight or angled abutments, describing
the axial relationship between the implant body and
the abutment.
57

SUMMARY

The dental implant now has been established as one of
the most preferred options for missing tooth replacement and
many dentists are already practising this procedure or are
willing to incorporate implants in their practise. Further, there
are now several implant systems in the market with different
implant designs and their specific components.
This range and variety may often make it difficult for the
novice dentist to understand and use implants and their
components.
Generic terminology has been developed to facilitate
communication among implant team members. Regardless of
the implant system used, the generic term is descriptive of the
function of the component rather than its proprietary name.
59

REFERENCES
• Glossary of prosthodontic terms.
• Glossary of Implant dentistry.
• Dental Implant Prosthetics, 2nd ed. Misch
• Misch CE, Misch CM. Generic terminology for endosseous
implant prosthodontics. J Prosthet Dent 1992;68:809–12.
60

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