Teeth and implants The tooth originally formed with in the jaws & erupted - PowerPoint Presentation

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Teeth and implants

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The tooth originally formed with in the jaws & erupted through the overlying mucosa in a complex series of biological event

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Gingiva versus per implant soft tissue:

The

gingiva

is that part of the

masticatory

mucosa

which covers the alveolar process and surrounds

the cervical portion of the teeth.

In healthy teeth the gingival margin is located on enamel.

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A complex array of gingival connective tissue fibres form well defined bundle groups:

Interdental

fibres

Dento

-gingival

fibre

Circular

fibre

Alveolar crest fibres

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Normal

gingiva

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Many of these fibres are inserted into the root cementum

(b /w the alveolar crest & cement enamel junction)

In the case of implant a transmucosal element protrude through the overlying mucosa which heal around it without cementum attachment

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circumferential and perpendicular connective tissue

no connective tissue insertion

no intervening

Sharpey’s

fiber attachment

The papillae which form around single tooth implant may be supported by collagen fibres attached to the adjacent natural teeth

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Junctional epithelium:

similar soft-tissue relationship to natural dentition

(

sulcular

epithelium)

hemi-

desmosome

like structures connect epithelium to titanium surface

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Biological width

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Probing depth examination

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Periodontal

ligament

&osseointegration

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“Osseointegration”

direct structural & functional connection between ordered, living bone & surface of a load-carrying implant & without interposition of fibrous CT membrane

BRANEMARK 1958

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Clinical definition of osseointegration

A process by which a rigid & a symptomatic fixation

Of an alloplastic material is obtained & maintained in bone while loaded functionally

ZARB – ALBREKTSSON 1991

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Osseointegration

Hematoma occurs near screw threads

After 3 weeks –

Osteoblasts

begin forming spongy bone

After 4 months – spongy bone replaced by compact bone Lamellar bone – strongest type of bone, most desired next to implant

Osseointegration failure

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Biology of bone

Two main categories

Endochonderal Intramembranous

e.g. Skeleton e.g. Mandible , Maxilla

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Bone morphology

woven bone

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Lamellar bone

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Composite bone

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Osteoblast

Function only in

the immediate vicinity

Of blood vessels

Originate from plueripotential

mesenchymal cell

Reduction in oxygen or

Micro movement or

Gross factors seem to alter their gene expression

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Osteoblast

Cover all active bone formation site

Bone formation always begin with the deposition of osteoid on the top of preexisting matrix which subsequently mineralized

They are secretary cell which are active during:

Embryogenesis

Maintenance

Repair

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Protein such as osteonectin , osteocalcin ,osteopontin & proteoglycan

Produce new bone

as well soluble signaling factors such as:(

BMPs,TGFB

, IGFI&II,INTERLUKEIN-1,PGDF

Control the activation of osteoclast (posses PTHr)

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Periosteum

Vital reactive layer of connective tissue covering bone

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Macroscopic structure

Cortical bone

(

combact

bone)

Dense skeletal tissue

composed of lamellar bone

Resistant to bending &torsion

e.g

Mandible:thick

cortics

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Trabecular bone

Low density osseous tissue

Composed of lamellar bone

Resistant to compression & intended

To respond quickly to the physiological need

e.g. Maxilla

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Bone healing events

Extravasations of blood

Blood clot formation

clot resolution(fibrin)

Blood cell migration(cell death & necrosis)

Mesenchymal cell migration(precursor)

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Large blood clot will form on

The larger bone spaces of

cancellous bone

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Key to implant success

Adequate stability & proper loading is the

key

1ry & 2ry implant stability

Loading condition

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Bone quality/quantity prosthetic design

Implant design number, width, & distribution of t

Macro the dental implant

Micro patient factors ;(

bruxism

Surgical technique and smoking)

Implant stability

Loading condition

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PERIMPLANTITIS & PERIODONTITIS

bacteria which are implicated in periodontitis, such as

Porphry-romonas

gingivalis

, are also the major pathogens in

destructive inflammatory lesions around implants-(periimplantitis)

Peri-implantitis affects the entire of the implant resulting in agutter of bone loss filled with inflammatory tissue extending to the bone surface

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I n contrast periodontitis affecting teeth commonly

have irregular loss of supporting tissues often confined to proximal surfaces & resulting in complex infrabony defects

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PERIMPLANTITIS

The incidence of

peri-implantitis

would appear to

be low, but can result in rapid destruction of the

marginal bone and is difficult to differentiate

from bone loss because of excessive forces.

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PERIMPLANTITIS

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Treatment of

perimplantitis

No difference between more complex procedures and conventional debridement in light forms of

perimplantitis

.

The adjunctive use of local antibiotics (

doxycycline

) to debridement showed an improvement of about 0.6 mm for PAL and PPD, after 4 months in patients affected by severe forms of

perimplantitis

(bone loss > 50%).

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conclusions

Osseointegrated

dental implants are useful alternative to natural teeth.

An understanding of the hard & soft tissue attachment mechanism & it’s surrounding oral environment is essential to all dentists who provide this sort of treatment

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Refrences

Albrektsson

TO, Johansson CB,

Sennerby

L 1994. Biological aspects of implant dentistry: osseointegration. Periodontal 2000; 4: 58-73

Binon

PP 2000. Implants and components: entering the new millennium.

Int

J Oral

Maxillofac

Implants 15(1): 76-94.

Introducing dental implant :

Jhon

A

HobkirK

, Roger M

Watson,Loloyd

J

J

Searson

BRITISH DENTAL JOURNAL, VOLUME 187, NO. 3, AUGUST 14 1999

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5.

Boyne PJ. Bone response to dental

intraosseous

implants. Dental Implants:

6.

Principles in Practice,

Babbush

C, Editor, Philadelphia, WB Saunders Co, Philadelphia, PA, 1991, pp 17-29.

7.

Roberts WE, Helm FR, Marshall KJ,

Gongloff

RK. Rigid

endosseous

implants for

orthopaedic

anchorage. Angle Orthodontist 1989;59:24

8.

Boyne PJ, Herford AS. Effect of configuration of surgical burs on osseointegration of dental implants: A pilot study. Implant Dentistry 1994;3:47-50

9.

Roberts WE. Bone tissue interface. J Dent

Educ

1988; 52:804-809.

10.

Roberts EW,

Poon

LC, Smith RK. Interface histology of rigid

endosseous

implants. J Oral

Implantol

1986;12:406-416

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11.

Huja SS,

Qian

H, Roberts WE,

Katona

TR. Effects of callus and bonding on strain in bone surrounding an implant under bending.

Int

J Oral

Maxillofac

Implants 1998;13:630-638.

12.

Garetto LP, Chen J, Parr JA, Roberts WE. Remodeling dynamics of bone supporting

rigidly fixed titanium implants:

ahistomorphometric

comparison in four species including humans. Implant Dent 1995;4:235-243

13.

Huja SS,

Katona

TR, Moore BK, Roberts WE.

Microhardness

and anisotropy of the vital osseous interface and

endosseous

implant supporting bone. J

Orthop

Res 1998;16(1):54-60.

14.

Brånemark

PI,

Zarb

GA,

Albrektsson

T. Tissue-integrated prostheses. Chicago,

Quintessence Publishing Co., Inc., 1985, p 11.

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Right now my life is just one learning experience after another……

By the end of the week I should be a genius!

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QUESTIONS ???

USS BRIDGE