المعال. دخيل حيدر د

والوجه – – الفم جراحة دكتوراه بوردوالفكين

– - والوجه الفم جراحة ماجستيروالفكين

– - والفكين والوجه الفم جراحة دبلومبرستل كلية مستشفى من تدريب شهادة

البريطانية الملكيةكلية مستشفى من تدريب شيراتة شهادة

في االسنان االلمانية زراعةالفكين و الوجة لجراحة العربي المجلس عضو

العراق في

Indication and contraindication of dental implants

History of Dental implant.

1906 used hallow wooden implant Green field then

1939 modified screw structures implant.

1944 used helical one. Fomiggini

1968 used leaf shaped implant, for better bone integration a planty of fracture.

1969 implanted titanum screw in the jaw dogs he get good tolerance. Braenemark

19 77 he established the concept of ossteo-integration . Braenemark

Standard Material. 1.Titanum why

A. Excellent bio-compatibility. B. No allergic reaction.

C.Excellent osseo-integration three to sex months.

2 .Ceramic A. Good aesthetic.

B. Good bio-compatibility. C.longer healing period.

D. Highly expansive. E. Need at least two years for osseo-

integration.

Dental implants. is a titanium "root" used in dentistry to support restorations that resemble a tooth or group of

teeth to replace missing teeth.

Dental implant composed of three parts :1 -the titanium implant that fuses with the jawbone

2 -the abutment, which fits over the portion of the implant that protrudes from the gum line

3 -and the crown which is created by a prosthodontist or restorative dentist and fitted onto the abutment for a natural appearance.

Surgical placement of the implant's into the bone. After surgery, there is a healing period of approximately four months. During this time, the implants fuse to the bone by a

process known as ‘Osseo integration  .’

Anatomic considerations include

A. The volume . B . Height of bone available .

Often an ancillary procedure known as a block graft or sinus augmentation are needed to provide enough bone for successful implant placement. Particularly for mandibular mental foramen , there must be

sufficient alveolar bone above the mandibular canal.

There are different approaches.

1 .Immediate post-extraction implant placement .

2 .Delayed immediate post-extraction implant

placement (2 weeks to 3 months after extraction).

3.Late implantation (3 months or more after tooth extraction) .

Success rates of implants .1 .Success will depend on the quality and

quantity of bone. The better the bone and the more available.

2 .operator skill . 3 .patient's oral hygiene, implants carry a

success rate of around 95%. 4 .Implant Stability Quotient ISQ value that

determine implant success is the achievement and maintenance of implant stability .

5.the patient's overall general health and compliance with post-surgical care.

Indication of implants.

1.People lose one or more teeth for a wide variety of reasons .

2 .To prevent teeth shift, rotate and become crooked .

3 .An improper bite will develop, making it very difficult to chew food properly .

4 .Spaces and gaps between teeth may cause embarrassment.

5 .Lack of confidence when patient smile.

6 .problems with speech.

7 .dentures that slip or cause sore spots when patient chew . dentures need to be relined

frequently because of bone resorption.

8 .Patient carry his complete or partial dentures in their pocket or leave them at home.

Contraindications

1 .Systemic. A. Uncontrolled type 1 diabetes is a

significant relative contraindication as healing following any type of surgical procedure is delayed due to poor peripheral blood

circulation . B. oral bisphosphonates (taken for certain

forms of breast cancer and osteoporosis) , evidence of bisphosphonate-associated

osteonecrosis of the jaw.

C. Patients with hepatitis B.

D. Patients with paget s disease.

E. Patients with candidal disease.

F. Patients with lupus erythromatosis with steroid therapy.

G. Serious systemic disease like rhumatoid arthritis or osseous disorder like osteomalacia

osteogenesis imperfecta .

H. patient who are immunocompromised due to viral infection(HIV) or cortico-steroids, oncology chemotherapy that delay wound healing.

I.Radiotherapy may induce vascular fibrosis and thrombosis .

J.patient under alcohol and drug abusers .

K.psychological patient or mental disorders.

2 .Local. A. Bony or soft tissues infection .

B. Inadequate bone apical to extraction site for implant stabilization .

C. Inability to provide occlusion from oral contamination.

D. Chronic problems such as granuloma or radicular cyst.

these present 2 difficulties bacterial contamination and bone loss ( periapically , and laterally ) which reduce

initial implant stability .

2.Behavioral Bruxism (tooth clenching or grinding) is

another consideration which may reduce the prognosis for treatment .

The forces generated during bruxism are particularly detrimental to implants while bone

is healing micromovements in the implant .

Complication-:

Such insult may cause irreparable damage to the nerve, often felt as a paresthesia (numbness)

or dysesthesia (painful numbness) of the gum, lip and chin. This condition may persist for life and

may be accompanied by unconscious drooling .

Failure of implants. 1 .Failure to osseointegrate correctly .

2 .Mobile bone, loss of greater than 1.0 mm in the first year and greater than 0.2mm a year after.

3 .Dental implants are not susceptible to dental caries but they can develop a condition called peri-implantitis, This is an inflammatory condition of the mucosa and/or bone around the implant which may result in bone loss and

eventual loss of the implant .

Peri-implantitis is usually, but not always,

associated with: A. A chronic infection .

B. Heavy smokers. C. Patients with diabetes.

D. Patients with poor oral hygiene. E. Cases where the mucosa around the

implant is thin .

4 .Risk of failure is increased in smokers .

5 .an implant may fail because of poor positioning at the time of surgery.

6 .overloaded initially causing failure to integrate.

7.In the majority of cases where an implant fails

to integrate with the bone and is rejected by the body the cause is unknown. This may occur

in around 5% of cases .

Reference1 . James RA. Subperiosteal implant design based on peri-implant tissue behavior. N Y J Dent 1983;53:407-414

2. Linkow LI, Kohen PA. Benefits and risks of the endosteal blade implant (Harvard Conference, June 1978). J Oral Implantol 1980;9:9-44

3. Branemark PI, Hansson BO, Adell R, Breine U, Lindstrom J, Hallen O, et al. Osseointegrated implants in the treatment of the edentulous jaw. Experience from a 10-year period. Scand J Plast Reconstr Surg Suppl 1977;16:1-132

4. BONE IMPLANT - United States Patent 3579831, accessed 2009-08-07 5. How does the timing of implant placement to extraction affect outcome? Int J Oral Maxillofac

Implants. 2007;22 Suppl:203-23 .6. Immediate versus delayed loading of dental implants placed in fresh extraction sockets in the

maxillary esthetic zone: a clinical comparative study. Int J Oral Maxillofac Implants. 2008 Jul-Aug;23(4):753-8 .

7. Osseointegration of zirconia and titanium dental implants: a histological and histomorphometrical study in the maxilla of pigs. Clin Oral Implants Res. 2009 Jun 15

8. Osseointegration of zirconia implants: an SEM observation of the bone-implant interface. Head Face Med. 2008 Nov 6;4:25 .

9. Fracture Strength of Zirconia Implants after Artificial Aging. Clin Implant Dent Relat Res. 2008 Jul 23 .

10. Osseointegration, Zard et al. Quintessence 2009 .11. J Evid Based Dent Pract. 2007 Mar;7(1):8-9 .

12. Doing implants? Make sure you’re up to scratch, warns GDC. general Dental Council Press Release, Thursday, October 30, 2008

13. Melo MD, McGann G, Obeid G. J Oral Maxillofac Surg. 2007 Dec;65(12):2554-8 .14. Jokstad A. Int J Oral Maxillofac Surg. 2008 Jul;37(7):593-6. Epub 2008 Mar 4 .

15. Addy LD, Lynch CD, Locke M, Watts A, Gilmour AS. Br Dent J. 2008 Dec 13;205(11):609-14 .16. Binon PP. J Oral Maxillofac Surg. 2007 Jul;65(7 Suppl 1):73-92. Erratum in: J Oral Maxillofac

Surg. 2008 Oct;66(10):2195-6 .17. Brisman DL. Int J Oral Maxillofac Implants. 1996 Jan-Feb;11(1):35-7 .

18. Berdougo M, Fortin T, Blanchet E, Isidori M, Bosson JL. Assistant professor, Department of Periodontology, Dental University of Lyon, France .

19. Becker W, Goldstein M, Becker BE, Sennerby L, Kois D, Hujoel P. J Periodontol. 2009 Feb;80(2):347-352 .

20. Gerds TA, Vogeler M. Stat Methods Med Res. 2005 Dec;14(6):579-90 .21. Fischer K, Stenberg T, Hedin M, Sennerby L. Clin Oral Implants Res. 2008

May;19(5):433-41. Epub 2008 Mar 26 .22. Bhola M, Neely AL, Kolhatkar S. J Prosthodont. 2008 Oct;17(7):576-81. Epub 2008

Aug 26. Review .23. The effectiveness of immediate, early, and conventional loading of dental implants: a

Cochrane systematic review of randomized controlled clinical trials. Int J Oral Maxillofac Implants. 2007 Nov-Dec;22(6):893-904 .

24. Albrektsson T, Zarb GA. Current interpretations of the osseointegrated response: Clinical significance. Int J Prosthodont 1993:6: 95-105

25. Extent of Peri-implantitis associated bone loss. J Clin Periodontol. 2009 Apr;36(4):357-63. Epub 2009 Mar 11 .

26. A review of dental implants and infection. J Hosp Infect. 2009 Jun;72(2):104-10. Epub 2009 Mar 28 .

27. Biology of implant osseointegration. J Musculoskelet Neuronal Interact. 2009 Apr-Jun;9(2):61-71 .

28. Recognizing and managing parafunction in the reconstruction and maintenance of the oral implant patient. Implant Dent. 2002;11(1):19-27 .

29. Training Standards in Implant Dentistry. The Royal College of Surgeons of England; London 2008

30. Policy Statement on Implant Dentistry. The General Dental Council; London. 9th April 2008