ردوة

Implantology courseImplantology course Basic courseBasic course

01-2014

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Dr kamal Masarwa

Dr. Kamal Masarwa

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Why ImplantsWhy Implants? ?

Indications Single tooth anterior

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Dr. Kamal Masarwa

Single tooth-Molar

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Multiple Implants to Replace Multiple Missing Teeth

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2 teeth missing

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3 teeth missing

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Free end

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Fully edentulous-Fixed Bridge

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1 -Ball Attachment

Fully edentulous- over denture

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Dolder Bar

Fully edentulous- over denture

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How can a dentist start to make Implants?

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Implantation

Transplantation

■Transfer of non-living tissue or material into a biological system

■Transfer of living tissue

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History of dental Implants

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TEETH WERE BOUND TOGETHER WITH GOLD WIRE

At an ancient burial site, dental bridges are excavated.  Most probably inserted post-mortem 2424

THE EGYPTIANS

sea shells

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Jaw of ancient Egyptian showing drill holes used in dental repair.Courtesy of the Gordon Museum

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THE MAYAS

Jade and turquoise stones are implanted in the teeth. 

strictly for ritual ,religious or purely self adornment purposes.

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In 400 BC, the use of gold orwood tooth-shaped implants was reported

Watzek G (ed), Blahout R. Historical Review. In: EndosseousImplants: Scientific and Clinical Aspects. Chicago: QuintessencePublishing Inc;1995:17-28.28

720-609 B.C was the first Reference to the therapeutic Extrction of teeth

Assyrian physician associated diseased teeth with a systemic disturbance and

recommended extraction in cases of oral sepsis

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THE GREEKS

HIPPOCRATES

writes about tooth decay

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Fingers or a thin linen towel were usedto cleanse the teeth .

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THE ROMANS

gold crowns

fixed bridgework .

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The earliest known dental prosthesis from Rome resulted from multi-karat gold wire

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The Siwak, a primitive form of toothbrush, is used for cleaning teeth

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The Favorite Dental Chair (circa 1901)

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1975

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الترجمه :القاسم ” ابو المشهور العربي الجراح أن ورد

) سنة ) حوالي وتوفي كوردوفا أسبانيا في عاش 1013الذيالعظم ” في اسنان زراعة عمليات اجرى قد .كان

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:نبذةالقاسم هو عباس أبو بن خلف

الزهراوي ،سنة توفي بالطب، 404اشتهر

فحسب .هجرية ^ ماهرا ^ احا aجر الزهراوي يكن ،لمواسعة خبرة ذا ^ حكيما كان .بل

من ^ مهما ^ قسما أفرد وقدوالحنجرة واألذن، العين، ألمراض ،كتابه

واللسان واللثة، األسنان، ألمراض ^ مهما ^ ،وقسماوالقبالة والوالدة، وفن النساء، ،وأمراض

والكسر الفك وعالج للجبر، ^ كامال ^ 4343.وبابا

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The first “Implants”

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Transdental Fixation

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Implant Types

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Lets remember some facts ….

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Subperiosteal Implants5050

Subperiosteal Implants

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Subperiosteal Implants

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In 1943, Dahl reported using a subperiosteal implant

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1- Subperiosteal Implants

Implant Types

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Transdental Fixation Transdental Fixation5757

Needle Implants5858

Needle Implants

Lambotte 1934 5959

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1- Subperiosteal Implants

Implant Types

2- Enossal Implants)needle(

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Types of enossal Implants

11 - - Needle ImplantsNeedle Implants

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Blade ImplantsBlade Implants6868

Blade ImplantsBlade Implants 6969

Blade ImplantsBlade Implants

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Types of enossal Implants

22 - - Blade ImplantsBlade Implants

11 - - Needle ImplantsNeedle Implants

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- -Disc ImplantsDisc Implants

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Types of enossal Implants

22 - - Blade ImplantsBlade Implants

33 - - Disc ImplantsDisc Implants

11 - - Needle ImplantsNeedle Implants

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Types of enossal Implants

44 – – Root form ImplantsRoot form Implants

22 - - Blade ImplantsBlade Implants

33 - - Disc ImplantsDisc Implants

11 - - Needle ImplantsNeedle Implants

- -Cylider ImplantsCylider Implants

- -Screw ImplantsScrew Implants8282

A - Cylider ImplantsA - Cylider Implants

44 –– Root form ImplantsRoot form Implants

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- -Cylider ImplantsCylider Implants

44 –– Root form ImplantsRoot form Implants

-performed

-cannot be removed

-Inserted with Hammer

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Stability development over timeStability development over time

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Placement Stability

Initial Stability

Primary Stability

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To increase the mechanical Stability…

functional surface area

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To increase the mechanical Stability…Ather way

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B - Threaded,screw ImplantsB - Threaded,screw Implants

44 –– Root form ImplantsRoot form Implants

The functional surface area of a threaded implant is greater

than a cylinder implant by minimum of 30% and may eceed 500% dependending on the thread geometry

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Types of Screw ImplantsTypes of Screw Implants

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screw Implantsscrew Implants

-More functional Surface

-Can be removed

-Inserted with Hand (no hammer)

-Self thread

-Less Boring (Bone Damage)

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Screw ImplantsScrew Implants

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The “Sargon” expandable implant

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Orthodontic ImplantsNEW

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Ivory seashells

bones of animals

teeth from human donors

Gold, platinum and other metal alloys

Implant Materials

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Professor Professor Per-Ingvar Per-Ingvar BrånemarkBrånemark

19521952

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Dr. Brånemark demonstrated that Dr. Brånemark demonstrated that under carefully controlled conditions under carefully controlled conditions

titanium could be structurally integrated titanium could be structurally integrated into living bone with a very high degree into living bone with a very high degree of predictability and, without long-term of predictability and, without long-term

soft tissue inflammation or fixture soft tissue inflammation or fixture rejection. Brånemark named the rejection. Brånemark named the

phenomenonphenomenon

Osseointegration106106

Osseointegration

“A direct structural and functional connection between ordered , living bone and a surface of a load-carrying implant “

BrBråånemarknemark 1985107107

Dorland’s illustrated Medical Dictionary (1994) defines osseointegration as ‘the direct anchorage of an implant ,without the growth of fibrous tissue at the bone-implant interface’(between Implant andBone.)

Carl Misch 2001Implant and restorative Denistry

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Machined SurfaceMachined Surface

BrBråånemark Implantnemark Implant

about 1 µm116116

healing period = 3-6 months

Bone growth around inserted implant= 0.6µm - 1µm / day

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How to decrease the time? 118118

To increase the biological Stability…119119

What happened with the bone after inserting an implant?

Resorption

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osteocytes

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Formation

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Osteozyt125125

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a bone cell attaching to titanium 128128

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There are Materials who increase the differentiation of osteoblasts .

Osteoconductiv characteristics

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1 µm

Bone growth= 0.6 – 1µm / day131131

so the Bone growth is

Faster

►Faster Osseointegration

►Less wait time for Laoding

If the Valleys are bigger,

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ציפוי ציפויطالءطالء

CaotingCaoting

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1-TPS (Titanium Plasma Spraying)1-TPS (Titanium Plasma Spraying)

6-10 biggerabout 15 µm 135135

2 - SLA (Sand Blasting and Acid-Etched)

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3 – HA )Hydroxyapatite) Coating

70% of the bone

Hydroxylapatite can befound in teeth and bones

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4 - TCP (Tricalciumphosphat(

Bioactive

Osteoconductiv

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BONIT is a BONIT is a fully resorbablefully resorbable bioactive coatingbioactive coating that is replaced by new bonethat is replaced by new bone in 6-10 weeks.in 6-10 weeks. This coating allows This coating allows early loadingearly loading of dental of dental and orthopaedic implants. and orthopaedic implants. The application is preferred on roughThe application is preferred on rough

implant surfaces.implant surfaces.

BONIT®coatingBONIT®coating

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►Affinity ,Attachment and Growth of

bone forming cells (osteoprogrnitors)

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Bioaktive Calcium-Phosphat -(CaP-)Coating

BONIT®coating 147147

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Are all Implants titanium maded?

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Metalfree Implantation151151

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