1. IMPLANTOLOGY QUESTIONS & ANSWERS
DR.MOUSTAFA MOAMEN
MDs. ORAL & DENTAL MEDICINE CAIRO UNIVERSITY
Assistant lecturer IN PROSTHESIS DEPARTMENT CAIRO UNIVERSITY
FELLOW TO THE INTERNATIONAAL CONGRESS OF ORAL IMPLANTOLOGISTS (ICOI)
PRESIDENT OF THE CLINICAL IMPLANT SOCIETY OF EGYPT (CISE)

2. COURSE OBJECTIVES THEORATICAL PART:
To be able to identify the advantages of implant dentistry
To be able to identify cases capable for implant placement
Practical part:
To be able to diagnose, place & successfully restore a single tooth replacement implant case

3. Then exam Implant Course map
System components & step by step procedures
Diagnosis & treatment planning
Basic knowledge
Then exam

4. What is a dental implant?
A device of biocompatible material placed within the mandibular or maxillary bone

5. Why do we need implants? P,O.C. Removable Fixed Implant Main prob
Tooth reduction
surgery
Survival rate after 10 years
35%
50 %
With precious alloys
85% -97%
Abutments
80% need repair within 10 years
& 44% will be lost
15% will need endo.
Abutment Screw loosening may occur  easily retightened
Increased mobility, plaque, bleeding upon probing, and caries of abutment teeth
Bone
Accelerated bone resorption especially from tissue supported restorations
Bone resorption from disuse atrophy under the pontics
Minimal to no resorption

6. What are the types of dental implant?
I. Endosteal implants
Root form implants
Endodontic stabilizers
Plate or blade form implant
II. Subperiosteal implant

7. How does healing take place around dental implants?
flap margins→ heal by primary intention
soft tissues → around implants simulates that around tooth structure i.e (attachment & junctional epithelia & free & attached gingivae all are present)
bone healing→
granulation tissues (within 1 week after implantation) → woven bone formation(within 2 weeks) → bone growth &mineralization(within 4 weeks) →bone maturation &organization(6- 8weeks)

8. What is osseointegration?
It is the direct structural & functional connection between living bone & the surface of a load bearing artificial implant without any intervening tissues

9. What are the criteria of a successfully osseointgrated dental implant?
Clinically immobile
No radiolucency around the implant
< 0.2 mm bone loss / year after the 1st year
Absence of signs &/or persistent symptoms as (pain, pus, paresthesia or infection)

10. What is meant by the available bone?
Available bone describes the amount of bone in the edentulous area considered for implantation.
It is measured in:
Width (buccolingual)
Height (from bone crest to landmark)
Length (mesiodistal)
angulation
crown height space

11. 1. The available bone height
The height of available bone is measured from the crest of the edentulous ridge to the opposing landmark.

12. 1. The available bone height
Minimum bone height needed:
Implant length (at least 10mm)+ 2mm
This additional 2-mm to permit for:
surgical error
osteoplasty

13. 1. The available bone height
Importance
Selection of the proper implant length which:
affects implant/crown ratio
affects primary stability immediate loading
↑↑ surface area(SA) (every 1mm contributes for 10-14% SA ↑↑) → better stress distribution

14. 2. Available Bone Width B-L dimension
The minimum needed bone width is:
2mm > implant diameter for predictable survival
These dimensions provide ≥ 1 mm of bone on each side of the implant at the crest.
Importance:
Determination of implant diameter which affects;
↑↑ SA (every 1mm →↑↑ SA by 30-40%) → Better Stress distribution especially around the implant crest which is the most vulnerable area for future bone resorption
Can we increase the bone width?

15. 3. Available Bone Length
The mesiodistal length of available bone in an edentulous area is often limited by adjacent teeth or implants.
As a general rule, the implant should be at least>1.5 mm from an adjacent tooth and 3 mm from an adjacent implant.

16. 3. Available Bone Length This dimension allows for
Crown contouring (emergence profile)
compensation for the width of an implant crestal defect, which is usually < 1.4 mm.

17. 4. Available Bone Angulation
Definition:
It is the angle between the long axis of the remaining alveolar ridge with the long axis of the abutment in the planned restoration
The initial alveolar bone angulation represents the natural tooth root trajectory in relation to the occlusal plane
the bone angulation changes after the loss of teeth, especially in the anterior edentulous arch
30˚

18. . Available Bone Angulation
Importance:
Bone angulation → placement of the implant with angled abutment → angled load to an implant body ↑↑ the crestal stresses, so the less the bone angulation the better the stress distribution

19. 4. Available Bone Angulation
Relation to ridge width

20. 5. Crown Height Space
The crown height space (CHS) is defined as the vertical distance from the crest of the ridge to the occlusal plane.
Importance:
It affects the:
Esthetics & appearance of the final prosthesis
and the amount of moment force on the implant and surrounding crestal bone during occlusal loading.
Maximum acceptable CHS
For an ideal treatment plan, the CHS should be ≤ 15 mm for ideal conditions

21. Implant patient should have Abundant available bone Money $$

22. Misch classfication

23. 8. criteria of division A (abundant) available bone ( Carl Misch classification)
Width > 6 mm
Height > 12 mm
Mesiodistal length > 7 mm
Angulation of occlusal load (between occlusal plane and
implant body) < 25 degrees
Crown height space ≤ 15 m

24. What is meant by bone density?
It refers to the internal structure of bone regarding its compact & cancellous components & reflects a number of biomechanical properties, such as strength and modulus of elasticity
As well as a determining factor in treatment planning, implant design, surgical approach, healing time, and initial progressive bone loading during prosthetic reconstruction

25. 9 . Classify bone according to quality?

26. Is bone density related to specific jaw locations?
0 % D1
10 % D2
50% D3
40 % D4
0 % D1
10 % D2
50% D3
40 % D4
3 % D1
50 % D2
46% D3
1 % D4 6% D1
66% D2
25% D3
3 % D4
3 % D1
50 % D2
46% D3
1 % D4
3 % D1
50 % D2
46% D3
1 % D4

27. Does bone density affect implant dentistry?
Difference between implant E & bone E will lead to implant micromobility inside the bone creating microstrain on the implant bone interface

28. Does bone density affect implant dentistry?
Implant to bone contact in D1 > D2 > D3 > D4 D1 D4

29. To summarize….. Bone density affects
implant micromovement during function
Bone to implant contact
So unfavorable bone density stress concentration

30. Does bone density affect treatment plan?
... unfavorable bone density stress concentration
... Stress = Force/Area
... to ↓ stress we have to ↑ surface area
• Implant number
• Implant width
• Implant length
• Implant design
• Implant surface condition

31. جزاكم الله خيراااااااااااااااااا