various implant systems in india final
TRANSCRIPT
VARIOUS IMPLANT SYSTEMS IN INDIA
DR.SACHIN
Contents
• Definition
• Classification
• Various implant systems
• Limitations
• Summary & Conclusion
• References
Introduction
Definition• Implant system (GPT, 1993): Dental implant
components that are designed mate together and implant system can represent a specific concept, inventor or patent. It consists of the necessary parts and instruments to complete the implant body placement and abutment components.
• Dental implant: is defined as a substance i.e., placed into the jaw to support a crown or fixed or removable denture.
Classification of Implants depending on
Implant placement within the tissues
Materials used
1.Epiosteal2.Endosteal
3.Transosteal
-Bioactive-Bioinert
-Biotolerated
Epiosteal 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.
• 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
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.
• In 1930 Strock placed first endosteal implant.
• It is a dental implant that extends into the basal bone for support
• It transects only one cortical plate
• It can be further classified into – Root form
– Plate form
Endosteal Implant
Root form Plate form
- Used over a vertical column of bone
- Available in four forms cylindrical, press fit, screw root, combination.
They are used for horizontal column of bone which is flat and narrow facial lingual direction.
Transosteal implants
• A dental implant that
penetrates both cortical
plates and passes
through entire thickness
of the alveolar bone.
Parts of in implant
• Body or fixture
• Healing screw
• Healing caps
• Abutments
Various Implant Systems
Branemark system
• Developed from the
pioneering work of
Prof. Per-Ingvar
Branemark who
introduced the term
osteointegration
Indications & Types
Types of fixtures in Branemark system
Fixture standard
Fixture self tapping
Fixture Mk II
Fixture Mk III
Fixture Mk IV
Conical Mk III
UniversalSelf tappingUsed in type I, II, III, IV
bone
TaperedDouble thread
Uses soft trabecular
boneBone type III & IV
Self tapping Used in
bone type I, II, III, IV
BRANEMARK SYSTEM COMPONENTS• FIXTURE –
• pure titanium with machined threads
.
• The top of the fixture has hexagonal
design & threads ..
• The apical portion tapered with four
vertical notches.
• COVER SCREW- seals the
coronal potion of fixture during the
interim period.
• ABUTMENT- -made of titanium in a cylinder shape. the apical portion has hexagonal shape to fit the coronal portion of fixture.
• ABUTMENT SCREW – insert through the abutment & threads into the fixture to connect the two components .
• GOLD CYLINDER- made of lAu , Pl, 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.
Screw-retained restorations
Multiple Unit Restorations
• Abutment options
• Multiple unit abutment (NP, RP, WP):
Indications: Short span ridges, full jaw reconstructions, available in several heights therefore possible to place the prosthetic margin above, at or below the gingival margin - esthetics
• Gold cylinder to fixture – connects directly to head of the implant eliminating the use of an abutment.
• Advantages – – For sulcus depth of 3mm or less
– Limited space
– Good esthetics
• Limitations– Casting procedure
Types of fixtures in Branemark system
Fixture standard
Fixture self tapping
Fixture Mk II
Fixture Mk III
Fixture Mk IV
Conical Mk III
UniversalSelf tappingUsed in type I, II, III, IV
bone
TaperedDouble thread
Uses soft trabecular
boneBone type III & IV
Self tapping Used in
bone type I, II, III, IV
Replace Select Tapered Implant System
• It can be used where the anatomic condition
where limit the placement of standard root
implant.
Indications
• Maxillary sinus• Labial concavities in the premaxilla• Lingual undercuts in the mandible • Converging roots of the adjacent teeth• Immediate extraction site
• It has 2 surface treatments i.e.,
Ti Unite surface: combination of titanium oxide
texture + porosity = optimal osteointegration
HA coated surface:
• Accelerates the deposition of bone to the implant
FRIALIT Implant system
• 1n 1974 Dr. Willi Schulte
developed Frialit 1 also
known as Tubingen
Implants
• Worlds first root analog
system
• Implant concept: Root analog stepped cylinder, stepped screws and synchro-stepped screw.
• Surgical indications: Immediate implant placement, delayed implant placement, late implant placement.
• Material: Medically pure titanium • Implant surface: TPS coating, HA coating (stepped
cylinder), DPS (stepped screw, Synchro stepped screw)
• Implant diameter: 3.4mm, 3.8mm, 4.5mm, 5.5mm, 6.5mm
• Implant length: 8 to 15mm• Anti-rotation: Internal hex
• Instruments: Drills, Bone Condenser, Bone Expander, Cortical Drill, Bone Profiler.
• Indications: Missing single teeth, free-end cases, tooth bound gapes, edentulous jaws
• Forming of soft tissue: Gingival formersGingiva formers: D 3.4 to 6.5, GH 1,2,3, and 5mm
• Abutments: Straight, customized crown abutments, telescopic abutments, screw retained, or cemented, CeraBase, AuraBase
Design
FRIALIT®-2 stepped cylinder :
• Stepped screw
• Synchro stepped screw
• The optimum implant for every situation
Stepped cylinder• Apex diameter in 3 to 5 steps by
0.4 to 0.6mm / step.• Coronal section of the implant
body has 1.5mm collar. • 3 longitudinal grooves • Deep internal implant abutment
connectionAdvantages of the FRIALIT®-2
stepped• Improvement of the implant site in
the event of low bone density• Atraumatic insertion in extremely
cortical bone• High stability, strong bone
adhesion at the titanium surface
The FRIALIT®-2 stepped screw
• First step – no threads, 1.5mm machine polished collar
• Self tapping thread from second step.
• Deep profile surface
• Cover screw in the silicon stopper
Advantages
• Implant can be inserted by finger pressure alone.
• Final position with ratchet implant driver.
• Increased osteointegration (DPS)
• Only 3 revolutions for complete seating
The FRIALIT®-2 Synchro stepped screw
• Crestal implant cervix – machine polished 0.4mm.
• Threaded deep profile surface has DPS.
• Cover screw in silicon stopper
Advantages• Applicable for all one
classes I to IV.• Atraumatic insertion• Increase self tapping in
cortical bone
Advantages
Implant abutment connection
• Tube-in-tube mechanism.• The rotation stop is secure by 1.5mm tall
and 2.5mm wide hex residual rotation less than 1°
• Highest mechanical stability by internal 3.4mm long parallel walled implant abutment connection for a secure occlusal load transfer
• Crown abutments have a groove at their base for sealing ring
• 3mm in diameter, biodegradable silicon – Bacteria proof sealing.
Color coding
FRIALIT®-2 colors provide
• Clear identification of the implant diameter
• Easy assignment of implant components
• Safe documentation
• Biocompatibility and resistance to the oral environment
Drills
Twist drill D
2.0
Round drill
Stepped Drill
D 3.4
Stepped Drill
D 3.8
Stepped Drill
D 4.5
Stepped Drill
D 5.5
Stepped Drill
D 6.5
8, 10, 11, 13 and 15mm
Advantages
• Optimum stabilization of the implant abutment interface
• Anti-rotational connection between the abutment and the implant
• Clear and secure positioning of the abutment on the implant
• No possibility of screw breaking or loosening
• Minimization of the risk of soft tissue perforation
ITI Implant System
• International team of implantology
• Types – – Hollow cylinder, – Hollow screw– Solid screw
• Single stage and 2 stage versions
• Consists of pilot drills, hollow traphine drills, depth gauges and twist drills.
Advantages
• The microgap between the primary and secondary components is supragingival – good peri-implant hygiene.
• The construction of the implant body is such that no second stage surgery for uncovering it is required.
Types
• TPS screw
• TPS hollow
Indications
• Symphyseal region between the mental foramen
• Single tooth replacement
• Bridge abutments
Design • Length 9,11,14,17 & 20mm• Width 3.5 to 4.2mm• 8 to 12 degree conical head with 4 slots – Prevents rotation.• Head: is internally threaded with 5mm deep socket which will accept 4-8mm
long, 2mm wide occlusal screws.• Neck: highly polished, slightly concave allows good oral hygiene and
gingival adaptation• Body: Ti plasma sprayed increases the surface area• Screw threaded with edges rounded - Causes the compression of cortical and
medullary bone. • Apex: Fluted, angled to 120° - permits self tapping
• The Standard Implant:one-stage or transgingival healing, mainly indicated for the posterior region.
• The Standard Plus Implant:for subgingival implant placement in the esthetic region.
• The Tapered Effect Implant:for immediate and early implantation in extraction alveoli.
Three prosthetic diameters are available:
• Narrow Neck:
Implants with the 3.5 mm Narrow Neck (NN) restorative platform
(Standard Plus Implant with a built-in octa abutment with external
connection, for single-tooth restorations).
• Regular Neck:
Implants with the 4.8 mm Regular Neck (RN), restorative platform.
• Wide Neck:
Implants with the 6.5 mm Wide Neck (WN), restorative platform
Immediate loading of edentulous arches.• The one-piece Monotype Implant with 8°
cone (endosteal diameter 4.1 mm) is specially designed for immediate loading with a bar denture.
• Because of the self-tapping thread, tapping is not necessary with this implant type.
Indications• Immediate loading in the mandible with a
bar denture supported by four implants
The solution for narrow gaps• The Narrow Neck prosthetic system is specially designed for situations
where space is limited in the lower incisor region and the upper lateral incisors.
• The NN prosthetic system offers cast-on gold copings and individually modifiable titanium copings (also available in an angulated version) for the 3.5 mm shoulder diameter so that a safe and esthetic restoration is ensured for both screw-retained and cement-retained solutions.
• Only screwdriver and ratchet with torque control device are needed to place the prosthesis.
Indications• Single-tooth replacement of the upper lateral incisors and the lower
lateral and central incisors
Cementing on a solid basis.• The Solid Abutment system for Regular Neck and Wide
Neck implants with its reliable Morse taper connection, ensures a secure and exceptionally stable abutment-to-implant connection to prevent loosening.
• The abutments are available in different heights. The abutments and corresponding transfer components are color-coded for accurate and simple prosthesis fabrication.
Indications• Cement-retained restorations with the crown and bridge
technique
Indications• Standard Implant Ø 3.3 mm
RN:used in limited alveolar ridge width
• Standard Implant Ø 4.1 mm and Ø 4.8 mm RN:All indications
• Standard Implant Ø 4.8 mm WN:Crowns and bridges in the molar region
synOcta for Regular and Wide Neck
Indications• All indications for crown and bridge
techniques
Advantages• All indications in the area of immediate and early
implantation
Core vent system
• Developed by Dr. Gerald Niznick in 1986
• Screw type designs with perforation or hollow basket
• Types– Core vent
– Screw vent
– Micro vent
– Bio vent
Core vent
• Made up of Ti alloy 90% Ti-6Al-4V
• Diameters – 3.5,4.5mm
• Threaded or beveled hex threaded
• Length –8, 10.5, 13 and 16mm
• Fixture having threaded screw design as a horizontal and vertical vent at the apex made up of CP Ti.
Screw vent• Smooth neck – offers the option
of placing the implant level with bone or 1mm above it.
• Screw vent is narrower than core vent
• Diameter 3.75mm• Length: 7,10,13,16mm• Made up of CP titanium threaded
at the apex – self-tapping easier.• Surface is acid etched.
Micro vent • Root form shape
• Made up of Ti alloy, Ha coating
• Diameters: 3.25, 4.25mm
• Length: 7, 10,13, 16mm
Bio-vent• Bullet shaped implant
• Hydroxyapatite coated has vertical slot and an apical hole offered in length 7,10,13,16mm.
• Main indicated in maxilla
Advantages
• Screw type helps in easy insertion
• Hollow cylinder type – good bone to implant contact.
• 8 different widths are provided for different types of bone.
Integral Implant System
• It’s a 2 stage implantation process
Indications
• Totally edentulous mandible or maxilla
• Fixed and removable bridge work
Design• Cylindrical shape
• Coated with dense HA
• Diameter: 3.25 to 4mm
• Length: 8,10,13, & 15mm
• The central core is a Ti alloy healing screw and gingival cuff
• Consists of drills : Pilot drill, rosette bur, intermediate spade drill and spade drill.
• Length: 8,10,13,15mm
Advantages
• Different diameters so wide selection for the dentist
• Cylindrical shape
• More favourable stress distribution
Pitt-Easy• The System The two-phase
• Cylindrical screw implant
• Made of pure titanium, with two different surfaces
• VTPS coating
• The vacuum titanium plasma spray coating
• Safe osseointegration.
• Fast bone regeneration surface .
Prof.Dr. h.c. Hans L. Grafelmann
Design• Different colours• Green code 3.25mm from 8
to 24 mm length• Yellow code 3.75mm from
8 to 20mm length• Red code 4mm from 8 to
16 mm length
Indications
• Freshly extracted sockets
• Extremely atrophied ridge.
• Mainly in frontal and pre-antral area.
• Seldom below the sinus and rarely in the tuber area
Advantages• Ensure precise and most atraumatic bone preparation• Due to the design, shape and dimension• Minimum alveolar bone resorption Good osteointegration• Tight cervical to apical adaptation of surrounding bone• Polished cervical portion • Establishes and immediate close friction fit at the marginal
bone entrance.• 5 months healing period
Bi-cortical Implants System
• Bi cortical screw is a screw type implant which finds
optimal support in bone i.e., bicortical support.
• One phase implant
• Self tapping• Pure Ti implant• Design
– Square– Universal round head
• Diameter: 2.5, 3.5, 4.5, 5.5mm• Length: 13, 14, 16, 19, 21, 23, 25mm• Smaller length: 21 to 26mm used in children (Standard length is 30mm)• Threads: 3, 4, 5• More effective self tapping helix with cutting segments each displaced by
30°.• Helix design has deeper arching with a progressive diameter upwards from
the apical tip.
Indication• Single tooth replacement• Bridge or bar abutments in anterior regions (Maxilla or mandible)Contraindication• Bone as little as 8mm • Insertion possibilities in maxilla are limited distally to the sinus. Advantages• Easy to handle • Simple insertion technique• Immediate and lasting stability• The bone particles cut during insertion are utilized for closer bone contact. • No post operative swelling• Little or no bone resorption
Osteoplate 2000 (Blade implant)
• Linkow blade implants invented in 1967.
• Long thin blade that will be surgically inserted into the
groove in the bone .
• Abutment projecting out from the blade to this crown or
attachment for denture can be placed.
• Osteoplate 2000 is developed by prof.dr.h.c.hans
l.Grafelmann
INDICATIONSIn the maxilla & mandible• Less than 4mm crest width (subnasal, labial atrophies or concavities - vertical
blade plate shapes• Presinus region (<3.5mm crest width) = asymmetric shapes• Subsinus region with insertion depths of <8mm and <4mm crest width (without
sinus lift surgery) = Horizontal maxillary shapes• In tuber area (rich marrow and prominent palatal undercuts) reduced or asymmetric
residual bone = tuber shapes• With posterior crest width of <4mm and available bone height atleast 6 to 8mm
above the mandible canal = shallow horizontal shapes.• With bone height 1 to 5mm above the mandible canal but >6mm in the ramus area =
ramus shapes.
Designs• Made up of pure Titanium
• Implant body use
• TPF coated
• Available in vertical implant & horizontal implant type with type B neck (trapezoid shape)
• Type A round neck
• Each implant is supplied with temporary post, cover screw and final post
Advantages
• Can be used in severely resolved ridges.
• Osteointegration is predictable (after 36 weeks)
• Shoulder thickness and neck design of Type B – helps in small atrophied alveolar ridges
BioHorizons Implant SystemIndications• Single tooth replacement (mandibular central lateral incisor, maxillary
lateral incisor)• Design: Square thread design – imparts 10 times less destructive
stresses, maximize compressive low transfer, Excellent primary stability• 3 different thread forms – for different bone density. • Square thread• Conventional V thread• Coronal 2/3rd parallel walls – initial stability, surgical simplicity. • Apical taper• Self tapping apex – simulates convergent roots
• Diameter: 3.5, 4, 5, 6mm. • Length: 9, 12, 15mm • Threads: D2, D3, D4• 6mm diameter implant – used in posterior extraction sites• 3mm implant – missing laterals mandibular incisors • Surface treatment – RBM (Resorbable blast media, Pure titanium oxide)• Hydroxyapatite – used in soft bone.• D4 type bone• D4 implant
Advantages
• Less marginal bone loss because of 0.5mm length
polished collar = better esthetics.
• Spiralock technology reduces the chances of screw
loosening.
IMTEC (Endure implant system)
• Has one stage and two stage implantation processDesign:• Diameter: 3.5, 4.3mm• Length: 11,14,17mm• Triple micro threading - Microthreads preserve
cortical bone at the crestal ridge – reduces bone stress
• 1mm polished collar • Abutment implant junction - Internal Hex plat
form • Natural anatomic tooth form
Innova Implant System
Endopore implants• Unique, truncated cone shaped
design, multilayout porous surface – 3 dimensional bone ingrowth.
• With threaded implants the fixation which occurs allow for rotation movement of the implant with endopore resistance to vertical, horizontal, and rotational movement.
• Implant abutment junction – Internal hex
– External hex
• Abutment platform 4.8mm
• Diameter 3.5, 4.1, 5mm
• Length: 5, 7 ,9, 12mm
• Collar height: 1.8-2.8mm -Smooth coronal region
• Abutment types are UCLA, UMA, Dalla Bona, Over denture system.
• Surface treatment – Acid wash surface, hydroxyapatite surface, TPS surface, Machine surface
Advantages• A secure, three-dimensional interlocking interface
with bone
• Predictable and minimal crestal bone remodelling
• Greater surgical options with shorter implant lengths
• An uncomplicated surgical sequence
• Minimal instrumentation and inventory
UNITI Implant System • Single or two stage surgical protocol.• Consists of straight abutment (4.3mm).• Tapered abutments • Ball abutmentsDesign• Diameter: 3.3, 3.7, 4.3, 5.3, 6mm – Based on every cervical
diameters of natural teeth.• Length: 10, 13, 15mm • Anatomic root shape• Upper 1/3rd – Cortical component of implant body is parallel sided
with shallow threads one continuous pitch of 0.9mm – ideal atraumatic placement in dense cortical bone – optimal load transfer.
• Lower 2/3rd – cancellous component – anatomic
taper and sharper, deeper threads (0.35mm) are
nearly horizontal – high degree of stability in
cancellous bone.
• Self cutting slots in the apical portion –
accommodates displaced bone volume during
implant insertion - prevents bone chips being
packed at the base of the osteotomy site.
• Implant tip is rounded
• Microgrip surface – osteoconductive high porosity
surface 1-5 micron.
• 1mm highly polished collar – better soft tissue
integration.
• Implant abutment connection – twin hexagon internal connection.
• The twin hexagon is sandwiched between two solid cylindrical guides above and below the hexagon – high degree of stability and stress distribution
• Microgap free and bacteria proof joint
• The deep internal connection with a abutment extending 3.3mm into the implant body – offers strength and stability.
Indications
• Single tooth replacement
• Single tooth replacement
• Multiple teeth replaceemnt
Advantages
• Biological root form suited for immediate extraction cases.
• Wide diameter neck + tapered form = ideal for peri-implant defect size in sockets (obviates additional augmentation materials)
• Wide platform – esthetic emergence profile.
• Tapered root – minimizes risk of damaging adjusting teeth and structures.
Astra Tech Implant System
• Two stage implant – manufactured from pure titanium
• Submerged implant
• Got unique conical seal design
• Surface treatment
• Grit blasting – Ti oxide particles
• Conical head
• Taper is 11°
Implant components • Fixture (length 8-19mm; Diameter 3.5 to 4mm)
– Self tapping– Parallel sided
• Cover screw• Abutments
– Healing abutment– Straight and angled abutment (20-30°)– Uni abutment (20° & 45°)
• Drills– Twisted drill– Tiger drill – Ti N coated with laser etched bands.
Advantages• Implant abutment junction is conical junction – prevents microbial contamination
IMZ IMPLANT SYSTEM
• Kirsch developed the IMZ implant system in 1974. Since 1978 it is in clinical use.
• Intramobile cylinder endosseous two stage osseointegrated implant.
• IME i.e., intramobile element is made up of polyoxymethylene was used as a shock absorbing element simulating PDL
• Available in 3.5 to 4mm diameter and 8,10,13,15mm length.
• Surface coating may be titanium plasma spray or plasma sprayed HA coated surface.
Indications
• Single tooth replacement
• Unilateral free end
• Bilateral free end
• Wide edentulous span
• Fully edentulous arch
Summary & Conclusion
References• Block & Kent’s Endosseous Implants For Maxillofacial
Reconstruction.• Elaine Mc Clarence ’s Close to the edge.• Hubertus Spikerman’s Color atlas of Dental medicine
(Implantology).• Malvin E. Ring’s Dentistry An Illustrated History.• Sumiya Hobo’s oseointegration and occlusal rehabilitation.• Ralph V. McKinney, Jr’s endosteal dental implants.• ADA council on scientific affairs Dental endosseous implants. An
update. JADA, Vol. 135, January 2004.
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