Implants

Introduction to Oral Implantology.

1- Concepts.
Oral Implantology is the science that studies dental Implants and their placement in the human jaws with the purpose of replacing missing teeth, as well as the prosthetic restorations to be built over them.
What is an implant?
According to the dictionary: Any device or material, especially of an inert substance,used for repairing or replacing part/s of the body.
What is a dental Implant?
A dental implant is an anchor that is inserted into a jawbone to provide permanent support for a crown, fixed bridge, or removable denture. It specifically replaces the roots of the teeth.

2- A brief history of dental Implants.
Ancient history - Egyptians shaped seashells and hammered them directly into the gums for the purpose of replacingteeth. Ivory and the bones of animals were also sometimes used to replace missing teeth.

Seashells in ancient Egyptian mandible.

1700s - Lost teeth were often replaced with teeth from human donors. The process was mostly unsuccessful due to immune system reactions to the foreign material.
1800s - Gold, platinum andother metal alloys were used experimentally and placed into sockets where teeth had been freshly extracted in an attempt to create suitable replacements. Long-term success rates were extremely poor.
1952 - A Swedish orthopedic surgeon, Dr. Per-Ingvar Brånemark, accidentally discovered that titanium can bond irreversibly with living bone tissue in a rabbit tibia. (Titanium is the same material thathas been successfully used in knee and hip replacements for more than 30 years.)

Rabit’s tibia from Branemark’s work.

1965 - The Birth of Modern Implants! The process of purposely implanting titanium in bone for the purpose of rooting prosthetic teeth began.
1960-1980- Several other dental professionals were investigating and practicing with dental implants, to mention a few: Dr. L.Lincow, Dr. Tramonte, Dr Ronald A. Bulard, Dr. Carl E. Misch, Dr. Tomas Albrektsson, etc…

Blade implants (Dr. L. Lincow). Samples of Early types of Dental implants.

1981 – Dr. Brånemark , also known as the “father of modern dental implantology” published a paper covering all the data he had amassed regarding titanium implants.
1982 -The Toronto Conference on Osseointegration in Clinical Dentistry created the first guidelines for what would be considered successful implant dentistry.
2002 - An ADA survey showed that oral and maxillofacial surgeons, periodontists, and general dentists near doubled the number of implants performed per dentist in only 7 years between 1995 and 2002.
Today – There are more than 220 dentalimplant systems, millions of successful implants have been performed worldwide and the discipline itself has revolutionized and changed dentistry as it was known before, turning implants placement into a routine procedure in any dental clinic.
3- Osseointegration.
Definition:
a) Branemark: “The formation of a direct contact between live bone and an implant surface functionally loaded, withoutsoft tissues between them, observed in optic microscope”.
b) The apparent direct attachment or connection of osseous tissue to an inert alloplastic material without intervening connective tissue.

Titanium-bone interface

Notice the importance of being “under functional load” because that attachment or bonding between bony tissue and the implant surface must be capable ofresisting the functional work of biting and/or chewing for a long term, as we will see this can only be achieved under certain conditions.
A titanium screw-shaped implant, or fixture, is carefully placed in the bone and, amazingly enough, the genetic code that commonly makes bone reject a foreign material is not activated. Instead nature allows bone cells to attach to the titanium surface and...