Implant Lectures 1-4

Fibre-Osseous integration (_________ osteogenesis) CT encapsulation of implant to mimic ______ No ___________ fibers, CT organized parallel to implant unlike PDL to tooth. No physiologic bone remodeling

Distant PDL Sharpey's

Intramucosal Inserts: proposed by ______ (1943) Button like nonimplanted retention devices __________CD or RPD; _________ RPD only No bone requirement; need ____mm thick mucosa Didn't really want to cover these. Buttons screwed into palate. Denture had a soft liner to cover the buttons. Would get inflamed and palate degeneration occurred.

Maxillary mandibular Dahl 2.2

i. when bone resorption and bone formation occur on separate surfaces (i.e. formation and resorption are not coupled). Causes change in Bone shape.

Modeling

the direct structural and functions connection between ordered living bone and the surface of a load carrying implant. Must be a load-bearing situation!

Osseo-inegration

father of implant dentistry. Bone inserts plus titanium didn't come out. Thought about dental implants - first was a surgical procedure. Then, decided to place implants where the teeth were supposed to be.

Per-Ingvar Branemark

a. Absorption of plasma proteins, platelet aggregation and activation, clotting cascade activation, cytokine release, nonspecific cellular inflammatory response, specific cellular inflammatory response, macrophage mediated inflammation

Phase 1: Inflammatory, days 1-10.

a. Neovascularization (new BV), differentiation, proliferation and activation of cells (osteoclasts and blasts), production of immature connective tissue matrix

Phase 2: Proliferative, days 3-42.

a. Remodeling of the immature connective tissue matrix with coupled resorption/ deposition of bone, bone remodeling in response to implant loading, physiologic bone recession

Phase 3: Maturation, after day 28.

i. is the replacement of old tissue by new bone tissue. Formation and resorption are coupled at same site. No change in shape.

Remodeling

Ramus frame: developed by ___________ and _________ in 1965 __________ (maxillary or mandibular?) edentulous arch "_________" contacts with bone for stability Inserted into ascending _______ and bony symphysis (areas least affected by resorption) Overdentures Requires: >___mm vertical and >___mm bone width (thin mandible! Ideal for this) He referred to this as the bar from hell. This comes out in pieces - tough to take out. Required a lot of space!! Not very common. Height of implants is a consideration.

Roberts Roberts Mandibular Tripod ramus 6 3

osseous implant is one-piece from bone through the oral mucosa (single crystal sapphire implants, ITI Swiss screw are examples)

Single Stage endosseous

i. almost entire bone is homogenous compact bone; 1. Need sharp drills, adequate heating control; Less blood supply than other types; 5 month heal/integrate

Type I bone

i. thick layer compact bone, dense trabecular core (ideal) 1. Oak wood vs. pine wood; 4 months to integrate/heal

Type II bone

i. thin layer cortical bone, dense trabecular bone core (ideal) 1. More cancellous, more time to calcify/fill in; 6 months.

Type III bone

i. thin layer of cortical bone, low density trabecular bone core of poor strength. (Be careful with heat - injures easily) 1. Styrofoam; longest time to integrate: 8 months

Type IV Bone

Transosseous: "staple" developed by Small in 70's Mandibular _______ (anterior or posterior?), requires general anesthetic Plate on inferior border with pins extending through bone to penetrate alveolar mucosa Various alloys: titanium, vitallium and ______ Predictable longevity Usually overdenture but can be FPD Requires: >___mm vertical and >___mm width of bone Problems: requires general anesthetic and invasive surgical procedure, cratering of crestal bone around threaded pins not uncommon Current transosseous staple implant: Bosker TMI marketed by W. Lorenz A gold alloy that integrates and can provide adequate support for a fixed or removable mandibular restoration. 'Gold is the only thing that bone will integrate to' Designed as functional implant for atrophic edentulous mandible (4 mm height) Won't see any more of these! Extra-oral approach - see these on females: chin lift, staples inserted extra-orally. Very thin joint connection between abutments and screws. Very technique sensitive. Thin, could break off. Then would need to place Endosseous implants.

anterior gold 9 5

Two-stage Endosseous

the bony implant is separate from the transmucosal portion - buried at level of bone, then have another surgery to place the abutment.